2 10 240 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h3>Circumcision booklet slammed by sexual health expert</h3> <h4>"A serious disservice to parents"</h4> <h4>BOOK REVIEW</h4> Brian Morris, In favour of circumcision. University of New South Wales Press, 1999 (Paperback, 104 pp, $16.95) Reviewed by Basil Donovan Director, Sydney Sexual Health Centre Professor Morris is a man on a mission to rid the world of the male foreskin. His book is targeted squarely at new parents, but he states that "doctors, nurses, midwives and other health professionals will also benefit". While the author says that the information in the book is intended "to give a balanced overview of the medical and other literature on the topic", even the most naÃ¯ve reader can see that, like all of its predecessors (both for and against circumcision), it is a very unbalanced book. The author is an eminent molecular geneticist, but not a clinician, though a layperson could be forgiven for failing to discern the latter fact from the author's biographical details. He gives himself away with his first clinical anecdote, received via email correspondence to the author's pro-circumcision website: <div>A concerned father: "We have a boy of two years and four months with balanitis and retraction problems (not confirmed). Right now it is 3 am, and my son is crying as he has done since yesterday. We are waiting until we can take him to his paediatrician. ... I feel bad at not having my baby circumcised when newborn. ... What can be done to relieve the pain until the doctor sees him? (Today is a holiday in my country.)"</div> A clinician would have advised this distressed father that we don't forcibly retract two-year-old foreskins. The lay readers of this book should also have been told this, but they were not. Moreover, balanitis is rarely so painful â€“ this child should be directed to an emergency department to have more sinister pathology excluded. Indeed, a number of the author's email correspondents seemed to have more serious problems above the belt than below it. But the author is not easily distracted from his mission. Immediately after his brisk preface about the value of the scientific method, he preys on parental fears with his (unreferenced) claims that the presence of a foreskin "serves as an impediment to sexual intercourse" and that "circumcision facilitates procreation". Perhaps he hopes that members of the target audience with shorter attention spans who fail to read any further will at least have been imprinted with these little gems. Job done. I will spare you the details, but thereafter the author discusses at length issues such as urinary tract infections in babies, zipper injuries, HIV and STD transmission, circumcision procedures ("pain is something that is experienced from time to time by babies"), phimosis leading to urinary retention and (ultimately) stroke and heart attack, penile cancer, prostate cancer, cervical cancer, aesthetics, sexual function, and even the difficulty hospital orderlies have inserting a urinary catheter into uncircumcised men. The list goes on, and the agenda remains clear. Needless to say, no mention is made of the total absence of randomised trials â€“ after all, if so many parents are equivocal about circumcision that there is a market for books like this, recruitment for such trials would seem quite achievable. The ubiquitous issue of socio-economic confounders (the presence [or absence] of a foreskin is typically an economic, ethnic or religious marker) is brushed aside, less drastic surgical interventions for men with phimosis are conveniently never mentioned, and the morbidity statistics are presented in their grimmest possible light. The author seems unaware that most balanitis is caused by Candida [a kind of fungus, commonly present on the skin], with only minor roles played by Streptococci and anaerobes, so the treatment of balanitis contributes nothing to global antibiotic resistance. Opponents of circumcision are variously dismissed in the book as being anti-Semitic, under the influence of hippies, convicted felons, on the lunatic fringe, members of a politically correct lobby to feminise men, or (at best) selective in the surveying of the evidence. Hmm ... Given this climate, it is no wonder that the medical colleges choose to sit on the fence. It appears that beauty is in the eye of the holder as well as of the beholder. In one of the book's numerous low points, the author reminds us that the character Elaine in the comedy series Seinfeld exclaimed that an uncircumcised penis "looks like an alien". The scientist, not content with anecdote, has stooped to the level of outright fiction. The slender data presented that supports an aesthetic preference for circumcised penises came from cultures where most men are circumcised. One can only speculate what the preference would have been if similar studies were presented from cultures where most men were uncircumcised â€“ or perhaps even from cultures where they are subincised. [a] Not surprisingly, the book concludes with a list of "points for and against" circumcision which provides 11 points in favour and one point against (that circumcision is a minor surgical procedure that carries with it small surgical risks). Readers of this journal may be particularly interested in the sixth summary point: <div>Lack of circumcision is the biggest risk factor for heterosexually-acquired HIV infection in men. By itself, the risk is eight times higher, but is even higher if lesions from other STDs are present. In an uncircumcised man the risk per exposure has been estimated as 1 in 300.</div> Let's address the second sentence first, remembering that the author has already told us to deplore those who are selective in their use of the evidence. Of the many studies that have looked at circumcision status and HIV risk, only one been approached an eight-fold risk for the uncircumcised, and they were members of an ethnic minority in Kenya. The bulk of the studies clustered around a relative risk of 1.37. Typically, the uncircumcised men were from ethnic minorities, and thus the association with HIV infection had a good chance of being confounded [b]. Indeed, when having a foreskin signalled membership of the ethnic majority, its presence ceased to be a risk factor for HIV infection. [1] It is possible that the author of this meta-analysis may also have had an element of selectiveness in his use of the literature, but at least he subjected himself to the peer-review process. The ball's in your court, Professor Morris. But what about the first sentence? What message does it send to the father of the baby boy whose physical integrity is under consideration? Let's hope the father has the wisdom to substitute either the word "condom" or the word "restraint" â€“ depending on your philosophy â€“ for the word circumcision. I would consider this sentence alone to be so dangerous that it provides sufficient grounds for the publishers to withdraw the book. I have no strong feelings about the medical indications for male circumcision either way. It is a culturally entrenched practice with mainly murky evidence to inform the debate. This sort of document adds to the murk and amounts to a serious disservice to parents. Basil Donovan is Director of the Sydney Sexual Health Centre and Clinical Professor in the School of Public Health and Community Medicine, University of Sydney. Reference 1. Van Howe RS. <a href="http://www.cirp.org/library/disease/HIV/vanhowe4/" rel="noopener" target="_blank">Circumcision and HIV infection: A review of the literature and meta-analysis</a>. International Journal of STDs and AIDS, Vol. 10, 1999, pp. 8-16 Source: Venereology, Vol. 12, 1999, pp. 68-9 <h4>Response by Brian Morris</h4> In his review of my book Dr Donovan would seem intent on misrepresenting the evidence I present in favour of circumcision. While I appreciate that the howls from both sides in this debate have caused the colleges, as he says, to maintain a stance of sitting on the fence, it seems clear that, contrary to his statement in the last paragraph of his review, that Dr Donovan does have "strong feelings about the medical indications for male circumcision". This is most evident in the single reference he choose to cite (by Van Howe) [1] to refute my review of the large number of studies that have been performed that show higher HIV incidence in uncircumcised men, even after adjusting for potential confounding factors. Dr Donovan surely must be aware that the same journal as Van Howe published his "meta-analysis" an article appeared resoundingly debunking the latter as "highly unsound methodology" leading to erroneous conclusions. [2] When an accepted approach was used an odds ratio of 3.0 (95 per cent CI 2.6-3.4) was obtained, so that "the evidence that lack of male circumcision increases the risk for HIV infection appears compelling, contrary to the contention of Van Howe's paper". Thus Dr Donovan's "the ball is in your court, Professor Morris" comment has been very well dealt with by Moses et al already. Dr Donovan takes my statement out of context, and contrary to what he says, I do advocate use of condoms (although perhaps he might like to comment on the relative ease of fitting one of these to a circumcised as opposed to an uncircumcised penis!?) [c] Basil knows me well enough to appreciate that I am an easy gong kind of person, not "a man with a mission". After all, my book started with a joke (which was modified by the publisher from little Johnny telling how he learnt at school that day that Sir Francis Drake had circumcised the world with a 60 foot cutter). As well as several chapters that summarise all of the medical research data published in peer reviewed international journals, the book also attempts to deal with more general aspects. Thus to broaden the scope of the book I also included a chapter on reproducing the personal accounts from men. These include the diversity of views "out there" concerning the circumcision issue. The fact that these were clearly not my words gets misconstrued in Dr Donovan's book review. I might add that most of the people with psychological problems who emailed me were clearly members or supporters of anti-circumcision groups. To all who emailed me seeking help I always emailed back telling them to see a medical practitioner as soon as possible, so I don't understand why Dr Donovan makes an issue about how he would have responded to "A concerned father" in an email account he reproduces from my book. I have been very grateful to Dr Donovan for his help to me in the supply of samples for my research years ago on validating molecular methods for HPV detection in cervical screening. While we may share a chat over a beer and I may laugh at his ringbarking comments, if he rolls a cigarette I might have to leave the room. Yes, medical researchers and clinicians are united in their thinking about many issues, but there are some matters where consensus has never, and may never be, reached. If my book clears the air a bit then I would be happy. Indeed, the intention of my book, as should be apparent to the reader, and as stated, is to inform â€“ especially on this issue, which has been the subject of an enormous amount of misinformation, hysteria and distortion by anti-circumcision campaigners. I feel it is my duty as an academic to present an up-to-date review and believe it does help push aside the murk, thereby helping parents and health professionals. The reader is free to consult the 170 references I cite for a fuller account. I point out that after properly studying the issues it is up to the reader to come to their own decision. I too would welcome further studies and would gladly present these in the similar balanced manner as I have done in my book. The Australian College of Paediatrics similarly reviewed the evidence and dropped its opposition to circumcision several years ago. [d] In the interests of sexual health, perhaps Dr Donovan should acknowledge that consensus of studies now affirm that there is a case in favour of circumcision. References 1. Van Howe RS. <a href="http://www.cirp.org/library/disease/HIV/vanhowe4/" rel="noopener" target="_blank">Circumcision and HIV infection: A review of the literature and meta-analysis</a>. International Journal of STDs and AIDS, Vol. 10, 1999, pp. 8-16 2. Moses S. Nagelkerkle NJD. Blanchard JF. Analysis of scientific literature on male circumcision and risk of HIV infection. International Journal of STDs and AIDS, Vol. 10, 1999, pp. 626-8 Source: Venereology, Vol. 12, 1999, p. 154 <h4>Response by Basil Donovan</h4> Perhaps it's timely to out my own views on the relationship between the foreskin and sexual health. Professor Morris may be surprised to learn that I had long suspected that the presence of an intact foreskin might increase the risk of men acquiring certain STDs. I base this starting point on an analogy with the well-documented greater efficiency of transmission of many STDs from men to women rather than from women to men. The sub-preputial space on an uncircumcised man would seem to me to present a larger and more hospitable target foreskin some pathogens, as does the vagina. Indeed, I find that I am able to help many uncircumcised men with chronic balanitis by drawing that analogy and getting them to wash out that space no more than once a day, plus minimising exposure to substances that are not friendly to the vagina, such as soap and antiseptics. [e] Armed with this hunch, rather than set up a website I chose to do some research. Australia is a good place to do such research because there is a roughly even population split for the intervention (circumcision) and in most cases it is not a maker of ethnicity, wealth, education or religion. Unexpectedly, our research findings were uniformly negative. [1] Circumcision did not protect against STDs in our clinic population, though we did not look at HIV because it is rare in heterosexual men in Sydney. We were careful to point out that the spectrum of STDs and access to facilities for genital hygiene â€“ that's code for running water â€“ differed between Sydney and most parts of Africa. This was even implied by the title of the article. Nevertheless, this honest bit of research, honestly reported, earned us the dubious title of "anti-circumcision campaigners". You may have noticed that that this area of human inquiry is riddled with name calling and other attempts at discrediting the messenger. I remain of the reversible opinion that, in certain settings, being uncircumcised is a risk factor for some STDs. But, to me, the question isn't whether or not; the key questions are "how much?" and "where?". No, Professor Morris, it is not legitimate to extrapolate blandly from east Africa to urban Australia. Nor can data on the relative safety of the surgical process derived from hospitals in industrialised countries be applied to situations where surgical skills and levels of infection control cannot be guaranteed. Could it be that in the countries where circumcision is safest it is least indicated? Answers to these questions are needed before the intervention can even be seriously considered. Questions that would then arise would include the acceptability and feasibility of mass circumcision. The ensuing public outcry would overwhelm and affect other important issues, such as vaccination. Equally importantly, limited resources would be diverted from more wide-ranging interventions, such as improving access to clean water, which could partly obviate the need for circumcision anyway. If I campaign against anything, I campaign against extremism and over-simplification of the issues. I selected the review by Van Howe [2] because Morris had chosen directly to attack him in his book. Among Morris's criticisms was that Van Howe's website was biased and that he avoided the peer review process. At least Van Howe can no longer be accused of the latter. Moses et al's letter [3] in response to Van Howe estimated an odds ratio of 3, derived from prospective studies in Africa. This falls far short of the 8-fold protection against HIV claimed by Morris in his book intended for Australian parents. I'm pleased to hear that Morris has become a condom advocate, because he wasn't in his book. Since he has not retracted his claim that circumcision is the most effective HIV prevention strategy available to most men, by inference ahead of condoms, I have to persist in condemning the book as dangerous. In response to his question about circumcision status and success with using condoms, I only have preliminary data to report. In one study [4] we found no tendency for uncircumcised men to indicate physical discomfort with condoms when compared with circumcised men. In another study [5], condoms slipped off circumcised penises more often. I call these findings preliminary because they await confirmation, and the second finding was unexpected. But these studies were omitted â€“ along with many others â€“ when Morris attempted to "summarise all [emphasis mine] of the medical research data published in peer reviewed international journals" in his book. Though, in Morris's defence, he did cite Reference 1. Similarly, his selection of clinical anecdotes could hardly claim to represent the "diversity of views out there", when not a single happily intact male got a voice. But never mind, Van Howe and his ilk are on the case. It's a pity that two wrongs don't make a right. Morris and I seem to be like spirits in urging further higher quality research on this topic. Heat of debate is no substitute for sound data in its proper context. References 1. Donovan B, Bassett I., Bodsworth NJ. <a href="http://www.cirp.org/library/disease/STD/donovan1/" rel="noopener" target="_blank">Male circumcision and common sexually transmissible diseases in a developed nation setting</a>. Genitourinary Medicine, Vol. 70, 1994, pp. 317-20 2. Van Howe RS. Circumcision and HIV infection: A review of the literature and meta-analysis. International Journal of STDs and AIDS, Vol. 10, 1999, pp. 8-16 3. Moses S. Nagelkerkle NJD. Blanchard JF. Analysis of scientific literature on male circumcision and risk of HIV infection. International Journal of STDs and AIDS, Vol. 10, 1999, pp. 626-8 4. Richters J., Gerofi J., Donovan B. Are condoms the right size(s)? A method for measurement of the erect penis. Venereology, Vol. 8, 1995, pp. 77-81 5. Richters J., Gerofi J., Donovan B. Why do condoms break or slip off in use? International Journal of STDs and AIDS, Vol. 6, 1995, pp. 11-18 Source: Venereology, Vol. 12, 1999, p. 155 <h3>Editorial notes</h3> a. The practice of slitting the underside of the penis (originally with a sharp stone), so as to open the urethra, as performed as an initiation rite among a few Aboriginal peoples in the central Australian desert. There is an interesting (if gruesome) paper on this by Jon Willis, covering the effect of the penis surgery undergone by Pitjantjatjara men in the course of their tribal initiations. This involves circumcision followed later by subincision, and then regular reopening of the wounds in all-male bonding rites, where blood must flow. The author shows that the combination of these surgeries cripples the penis so effectively that the men have very little interest in or capacity for sex, and suggests that the only place where it would feel remotely comfortable if touched is inside a very soft and well-lubricated vagina; anywhere else, touch on the penis would be too painful. Jon Willis, "Heteronormativity and the deflection of male same-sex attraction among the Pitjantjatjara people of Australia's Western Desert", Culture Health and Sexuality, Vol. 5, 2003, pp. 137â€“151 b. That is, holding the foreskin responsible for differences in sexual behaviour or contacts produced by the person's membership of a particular ethnic, religious or other social group, where that adherence determines the kinds of sexual behaviour engaged in or the range of his sexual contacts. The <a href="http://www.cirp.org/library/disease/HIV/cochrane2003/" rel="noopener" target="_blank">authoritative Cochrane Review</a>, concluding that circumcision could not be recommended as an effective AIDS strategy in Africa, noted that confounding was a serious problem with nearly all the studies which claimed to find an association between lack of circumcision and greater susceptibility to HIV infection. c. One wonders as to the extent and sources of Professor Morris's experience on this point. d. Blatant misrepresentation, contradicting Morris's earlier comment that the colleges were sitting on the fence. Although the paediatricians' 1996 statement was weaker than that of 1983, it maintained their opposition to routine circumcision, a stance that was more strongly affirmed in 2002. <a href="http://www.circinfo.org/previous_statements.html" rel="noopener" target="_blank">Previous policy statements</a> <a href="http://www.cirp.org/library/statements/" rel="noopener" target="_blank">Statements by other medical authorities</a> e. "Balanitis" (any inflammation of the glans) is more likely to be caused by excessive washing and irritation from soap than by its natural covering. <a href="http://www.cirp.org/library/disease/balanitis/" rel="noopener" target="_blank">Further information</a> Not to be confused with the more serious (but very rare) lichen sclerosis, or <a href="http://www.cirp.org/library/treatment/BXO/" rel="noopener" target="_blank">Balanitis xerotica obliterans (BXO)</a> </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Brian Morris reviewed darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> 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 â€“ 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. <h2>Shane Peterson's story</h2> The following account was written in 2000, when the author was 27 years old and studying for a PhD at the Australian National University. <h3>Introduction</h3> I am a 27-year-old postgraduate student (doing PhD) who was badly injured by a routine neonatal circumcision performed within days of my birth. For the last nine years, I have struggled to cope with this injury and to seek legal redress for my suffering, while at the same time I have successfully pursued a career in medical science. I recently achieved a precedent-setting legal victory in Australia with an admission of liability and AU $360,000 in damages for my injury. I view routine circumcision as an act of assault and a breach of human rights, and I am dedicated to the eradication of this unnecessary and potentially disastrous procedure. <h3>Overview</h3> This article is an account of my experience of the possible, and largely unpublicized, complications that can arise from routine neonatal circumcision. Circumcision and other forms of male and female genital mutilation originated in primitive societies and have been practiced for several thousand years. Despite this long tradition of mutilation, the resulting complications, injuries and deaths have been consistently unreported. Ironically, many contemporary advocates of male circumcision claim that the historic development of this practice in primitive societies is evidence that male circumcision is beneficial to health. For example, circumcision advocates Szabo and Short [1] claim that male circumcision is depicted in a controversial relief from the Old Kingdom tomb of Ankhmahor at Saqqara, Egypt. This relief may be one of the oldest records of male genital mutilation in the ancient world, and dates from around 2400 BC. [2-3] A number of trained Egyptologists, however, doubt this claim. A number of alternative interpretations have been offered by experts in the field. Some Egyptologists argue that this is a scene of a ritual shaving, [4]while others suggest that it might be a scene of emergency dorsal slit surgery to relieve a case of paraphimosis. [5] Even if genital mutilation is depicted in this relief, controversy exists over the similarity of this practice to circumcision, and its cultural significance to the Ancient Egyptians. [6] Regardless of the type of genital mutilation depicted in the Ankhmahor tomb relief, it is apparent that one man has been forcibly restrained. This can be interpreted as involuntary genital mutilation. The relief provides evidence that, since ancient times, it has been normal for individuals to be very unhappy and distressed when forcibly subjected to an act of mutilation. All forms and degrees of genital alteration, including circumcision, have always been a phenomenon that should be a matter of personal choice. <h3>Major life events</h3> I was born and circumcised in Western Australia in 1973, but was unaware of any genital abnormality as a young child. Because I was circumcised as an infant and not informed of this fact, I was not aware that my body had undergone any surgery. I had no reason to suspect that I had a penile problem until puberty. At the age of 18, in 1992, I underwent reconstructive surgery. The outcome of this surgery was exceedingly disappointing, and I attempted suicide six months later. In 1993, six months after the suicide attempt, I underwent further surgery. Between 1993 and 1997, I concentrated on pursuing my academic career and resolving the emotional and ethical issues associated with my injury. I first sought legal advice in 1994, then commenced a legal claim for medical negligence with a Writ of Summons issued in October of 1997. This claim was finalized in 1999 with an admission of liability and payment of damages. I have since had several interviews with the media and am now dedicated to promoting public awareness of the detrimental affects of routine circumcision. <h3>Birth and circumcision</h3> My early childhood was happy. I had many interests, most especially in science. I was unaware of any complications with my circumcision. The circumcision scar was at the extremity of the penis, just below the corona glandis. Having no conception of what my penis looked like prior to circumcision, I was completely unaware that the family doctor who circumcised me had removed not only the foreskin but also most of the penile shaft skin. He then pulled up the scrotal skin and stitched it just under the corona. As an infant and young child, the excessive removal of skin was less obvious because of the lack of pubic hair. There were two reasons why my parents decided to have me circumcised. First, my father had been circumcised shortly after birth, and was unaware he had lost tissue of any value. Second, my father's younger brother was spared circumcised as an infant but was subsequently circumcised at the age of eight, allegedly due to painful adhesions, bleeding, and repeated infections. My father remembered how traumatic this experience was, and my parents wanted to spare me from suffering similar problems. From information provided later by my grandmother, it appears likely that my uncle's "problems" were actually the result of repeated, forcible premature retraction of the foreskin for cleaning during infancy. My mother had concerns about circumcision. She was a young mother of 17 years and knew nothing about how circumcision was performed, what risks were involved, and what the expected result should be. When family members suggested that she should have her unborn child circumcised if it was a boy, she sought advice from her family doctor during a prenatal check up. She was advised not to worry: "Just one little snip and it would all be over." The doctor assured her there were no risks and that it was such a simple procedure that Jewish mohels, with no medical qualifications, could perform circumcisions. Consequently, I was circumcised by this family doctor. My parents did not notice that anything was amiss during my early childhood. My mother does recall the penile skin appearing very tight during erections when I was a baby. She thought little of this, as my father's penile skin was similar. <h3>Adolescent years (1986-1990)</h3> With the onset of puberty between the ages of 12 and 13, I became aware of pubic hair growth and penile erections. These erections were very tight and painful, with the hair-bearing scrotal skin pulled up onto the penile shaft. With the onset of this pain, I suspected that my penis might be abnormal. There was, and still is, however, a lack of available, accurate information about the normal anatomy and function of the penis. Instructors for the sex education classes at school advised that it was normal for adolescents to feel concerned that the changes taking place in their bodies during puberty might not be normal. We were taught that these doubts are a normal part of growing up and there was no need for concern. Although I took this advice and tried not to worry, I still suspected that I had been born deformed. The severity of the problems increased as I progressed through my teenage years at high school. As the penis grew, the skin became tighter and more painful, and the bending of the penis to the left became more apparent. This physical deformity had a major impact on my confidence and self esteem. I was reluctant to use public change rooms after physical recreation classes and tried to avoid sporting activities. I became very shy, self-conscious, and found it difficult to interact spontaneously with other teenagers my age. Because of these difficulties, I withdrew socially and made less of an effort to make friends. Because I often appeared quiet and shy, I was susceptible to victimization. I was bullied and bashed on a regular basis. Because I did not make my interest in the opposite sex obvious in a chauvinist manner, I was, occasionally, labelled as 'gay.' This experience indicates to me that I live in a prudish society that is unable to deal competently with sexual issues. <h3>Young adult years</h3> In 1991, at the age of 17, I was relieved to escape the bullying environment of high school and commence university studies. At that time, I believed I could achieve my life ambitions by succeeding at university. Unfortunately, by this time, the severity of the erectile deformity, tightness, and pain had increased to the extent that I could no longer achieve a full erection. As a university student, I was exposed to relationship and sexual issues. Although I met people I felt attracted too, I was unable to deal with these issues because of my belief that I had been born deformed and would be rejected. At this time, I was still unaware that my deformity was due to a circumcision injury. I felt very ashamed of my deformity and was unable to seek help. This situation led to anxiety and depression, and I failed courses at university. The depression and anxiety, combined with the lack of success at university, eventually overwhelmed me. I did not know what do and regularly contemplated suicide. Although I had previously been sexually attracted to the opposite sex, at this point in my life I began to consider alternative options. During my second year at university, in 1992, I reached a crisis point. I felt compelled to confide in someone, so I told my mother. My mother was shocked and immediately suspected the deformity could be related to my circumcision. This was the first occasion that either one of my parents had ever mentioned that I had been circumcised. I made an appointment with my family doctor on 11 April 1992. This appointment was not with the doctor who had delivered and circumcised me. I had seen my family doctor regularly from the age of six months. During the examination, the physician took one look at my penis and said that whoever circumcised me had not known what he was doing. The doctor informed me that I had suffered an aggressive circumcision, and that far too much skin had been amputated. He then referred me to a urological surgeon, whom I saw on 23 April. The urological surgeon examined me more closely, but appeared reluctant to admit that my penis had been damaged. He commented that if anything was wrong, it was not obvious. After I insisted that a problem definitely existed, the urologist conceded that any potential problems would be more apparent upon an artificial erection. When I asked if the problem could be repaired, the urologist informed me that the tissue removed by the circumcision could never be replaced. I was told that I might just have to put up with the situation. This scenario was intolerable to me, so the urologist referred me to a plastic and reconstructive surgeon. I was examined by the plastic surgeon on 7 May 1992. This surgeon specialized in the treatment of severe burn victims, especially small children. Upon examination, the plastic surgeon advised that my injury would be very difficult to treat, but she believed that she might be able to improve my situation. <h3>My reaction</h3> It was difficult for me to cope with the above events, all of which took place within the space of only one month during the first university semester of 1992. I was shocked and angered to learn that I had not been born deformed, but was injured because my body had been interfered with by another person. I hated the family doctor who circumcised me, and I hated my parents for allowing it to be done. I began to feel disgust towards Australian society, which has historically maintained that routine neonatal circumcision is a beneficial practice. I also resented members of my extended family who were reluctant to believe that I was seriously injured by a simple procedure that, in their minds, removed only "the useless piece of skin on the end of a man's dick." <h3>Research findings</h3> As a university student, I was trained in research skills and had access to medical libraries. I began to research the topic of circumcision intensively in order to explore possible treatment options. The results of my research were dismaying. I was angered to find that my circumcision had been completely unnecessary from a medical standpoint. [7] I was horrified to find that, in addition to excessive skin removal, circumcision results in a range of injuries referred to as "complications." [8-11] I suspect that this sort of ruse serves to dissociate the blame of the injuries from the surgery that caused them. Such injuries include: 1. Haemorrhage [12] 2. Urinary retention [13] 3. Meatitis, meatal ulcer and meatal stenosis [14] 4. Adhesions or skin bridges [15-16] 5. Infection: including gangrene, [17] septicemia and meningitis [18] 6. Chordee [19] 7. Cysts [20] 8. Urethral injury and fistula [21-23] 9. Hypospadias and epispadias [24-25] 10. Impotence [26-27] 11. Psycho-social issues, such as schizophrenia [28-29] 12. Amputation or necrosis of the glans [30-32] 13. Total necrosis, ablation or amputation of the penis [33-35] 14. Death [36-37] I was stunned to learn that in cases of penile amputation during routine neonatal circumcision, infants have been surgically reassigned to the female gender. [38-40] There are many ways by which an unnecessary routine circumcision can destroy a man's life, and not all of them are listed as complications. Many of the most frequent complications, as in my case, are seldom listed as such. All complications, both major and minor, can exert a negative impact on the quality of a man's life. This is especially true when circumcision is imposed on an individual without his permission, as is always the case with routine neonatal circumcision. I also learned from my research that the quantity of skin removed during neonatal circumcision is highly variable between patients. [41] It is evident that excessive skin removal is one of the most common injuries. [42] Indeed, one contemporary urological textbook includes a subheading under circumcision: <div> Disasters: Too much skin removedâ€¨ Take the excised foreskin (pick it up off the floor, if necessary!) and stitch it back in place. Often, it will take as a free graft. If it does not, graft the penis with skin taken from a hairless area. [43] </div> If a victim's skin is not picked up off the floor and reattached, a far less satisfactory option is reconstructive surgery involving skin grafts to the penis in an attempt to replace the excess removed during circumcision. I also learned that the penile skin, mucosa, and nerves that are removed by circumcision can never be replaced, [44] and skin-graft recipients can be very dissatisfied with the results of such surgery. Grafted skin is not a satisfactory surrogate for the penile skin and mucosa and lacks the necessary innervation, elasticity, and suppleness. It is interesting that the highly unique characteristics of preputial tissue make it an excellent candidate for grafting to repair dermal trauma of other areas of the body, such as severe lacerations or burn injuries. [45] <h3>Life options</h3> My options in early 1992 were to endure my circumcision injury for the rest of my life, commit suicide, or try surgery. By this time, I had seriously considered suicide for more than a year. Rather than enduring the circumcision injury for the rest of my life, suicide represented an attractive option, as it would free me from my physical pain and psychological trauma. First, however, I chose reconstructive surgery as the only available option before the final resort of suicide. While reviewing the medical literature, I was interested in function more than cosmetics, and took an evidence-based approach. If a sex-change operation would yield the most functional end result, I might even have pursued that option. After assessing the medical literature, however, I was satisfied that penile reconstruction with skin grafts was more likely to achieve a functional result than a gender reassignment. The option of non-surgical skin stretching requires special consideration. Although it is likely that I lacked sufficient remaining skin to stretch, I am disappointed that I was not made aware of this alternative in 1992. Unfortunately, non-surgical options were not presented in the literature that I surveyed nor offered by my surgeons. I have observed that medical practitioners are generally immersed in a surgical paradigm and often fail to advise patients of less invasive alternatives to surgery. Surgery is one of the most invasive and high-risk forms of medical intervention. As such, surgery should always be the absolute last resort for the treatment of a condition, to be employed only after all other less invasive options have failed. <h3>Reconstructive surgery</h3> I underwent reconstructive surgery on 30 June 1992. A full-thickness skin autograft of 12 cm by 14 cm was harvested from my left thigh for grafting to the penis. The thigh was the only prospective donor site that was large enough to supply a graft of the appropriate dimensions. A split-thickness graft was then harvested from my right thigh and applied to cover the exposed subcutaneous tissue at the left thigh donor site. Overall, the reconstructive procedure resulted in two large wounds to my thighs. A full-thickness skin graft is composed of the full thickness of skin (dermis and epidermis), with the dermal surface of the graft trimmed of the underlying fat or subcutaneous tissues. [46] A split-thickness graft contains only the epidermis and a portion of the dermis. Although a split-thickness skin graft involves less trauma to the donor site, these grafts tend to be brittle and often contract when placed on unsupported tissue. My surgeons grafted a full-thickness of skin to the penis out of concern that a split-thickness graft might contract and erectile function would again be restricted. <h3>Description of penis before reconstruction</h3> Prior to reconstruction, the circumcision scar was very prominent and had migrated towards the base of the penis, due to the tethering and tension. The remnant inner preputial mucosa was stretched and distorted, with pitting and scarring evident. The shape of the glans was also distorted by the tension. The circumcision scar was highly irregular, as excision of the preputial tissue was asymmetrical, with more skin removed from the left side of the penis, than the right side. This created tethering and deviation of the penis towards the left upon erection. During erection, due to the extreme skin deficit and tension, the scrotal skin migrated more than two thirds of the distance along the penile shaft towards the glans. A damaged remnant of the frenulum remained, which was particularly sensitive. As occurs in all circumcisions, the normally moist glans mucosa underwent keratinization and has been covered by a dry layer of dead epithelium. This represents a further reduction in sexual sensitivity of the penis, in addition to that caused by excision of the preputial mucosa and erogenous nerve endings. <h3>Operative procedure</h3> An artificial erection was produced by placement of a tourniquet around the base of the penis and injection of normal saline solution into the left corpus cavernosum. The chordee (deviation) of the penis to the left was made quite evident through this procedure. Next, an incision was made along the circumcision scar. Upon release of the tension, the hair-bearing scrotal skin retreated to the base of the penis. The underlying connective tissue (Buck's fascia) was completely exposed, illustrating the severe skin deficit due to the removal of almost all the shaft skin by the neonatal circumcision. Another critical observation made at this stage of the operation was the complete absence of the dartos fascia. This abnormal situation, caused by the original circumcision, was not detected until this stage of the surgery. The dartos fascia is a delicate layer of areolar tissue that assists with the mobility of preputial tissue over the penis. [47] It should not be completely removed during circumcision, and its removal in my case resulted in painful adhesions between the remnant preputial mucosa and underlying Buck's fascia. These adhesions caused further tethering of the penis. In conjunction with the excessive and asymmetrical excision of preputial tissue, the absence of the dartos fascia and resultant adhesions would have rendered non-surgical techniques of skin stretching ineffective. The remnant preputial mucosa was subsequently excised due to adhesions to the Buck's fascia. With excision and the release of tension, the preputial mucosa contracted to one fifth of its pre-operative size. Post-operatively, I discovered that removal of this mucosa had resulted in a dramatic loss of sexual sensitivity. I could not have appreciated the significance of this loss had I not experienced it myself. This loss is made all the more significant when combined with the sensitivity lost as a result of the large amount of preputial tissue removed during the original circumcision. Therefore, having experienced a "second circumcision", I can attest from experience that circumcision dramatically reduces sexual sensation. The full thickness skin graft from the left thigh was placed around the penis. The skin graft was attached to the penis with Histoacryl tissue adhesive (Braun) with the suture line along the underside of penis in the position of the raphe. Surgery concluded with the application of a compression bandage to secure the skin graft to the penis and facilitate the establishment of a blood supply. The thigh donor sites were also bandaged. Postoperative pain was acute, and pethidine injections were given at the base of the penis at two or three hourly intervals for one week. Similar pain was also experienced in the donor sites. <h3>Short-term results</h3> The end result of the surgery was more aesthetically pleasing than the appearance when the bandages were removed, one week post-operatively. A large amount of swelling was evident, and I was surprised that any part of my body could swell to such a large size. The skin graft had an unpleasant consistency of thick, dried leather. With the topical application of vitamin E oil twice daily, the graft gradually became more supple over a period of several weeks, and the swelling subsided. Unfortunately, as the suppleness and elasticity of the graft increased, the graft contracted as it does not express the genes and hormones that instruct natural penile skin to remain loose. A series of ridges formed, which later developed into red hypertrophic scarring. The graft also developed hair due to follicles inadvertently transplanted with the graft from the thigh. The donor site wounds were very similar to burn injuries, and were treated as such. DuoDERM E, a semi-permeable polyurethane wound dressing, was worn for several weeks post-operatively to facilitate re-epithelialization and reduce pain. [48] After wound closure was complete, the thigh donor sites also developed prominent red hypertrophic scarring during the healing process over subsequent weeks. To reduce the hypertrophic scarring of the penile graft and thigh donor sites, I was advised by the surgeon to massage twice daily with vitamin E oil, and wear compression bandages on the donor sites as much as possible. Although very inconvenient and uncomfortable, I disciplined myself to massage with vitamin E oil and wear the compression bandages as directed. Although not directed to do so, I also wore condoms to compress and assist in scar reduction of the penile skin graft. Compression bandages and condoms were worn for over two years postoperatively. <h3>Electrolysis</h3> In June 1993, electrolysis was performed to destroy the hair follicles transferred with the graft from the thigh to the penis. A steroid injection was also given to assist in scar reduction for the penile skin graft. Unfortunately, the outcome of electrolysis was horrific, with extreme swelling and pain. Due to the fragility of the penile skin graft, necrosis and atrophy of tissue occurred in a radius of several millimeters around each electrolyzed hair follicle. Although these wounds have healed, dark scars and pitting remain. <h3>Long-term results</h3> The penile skin graft reduced tethering and enabled fuller erections. Upon erection, the penis became longer and the deviation to the left less severe. The remaining deviation is due to the restricted growth of the left corpus cavernosum - a permanent result of the tethering during puberty. This deformity demonstrates that penile growth and development are severely restricted when the penis is denuded by circumcision. The prominent scarring of the thigh donor sites is an unpleasant outcome of the surgery, as the damage caused by the neonatal circumcision has disfigured other areas of my body. These bright red scars were prominent while I was naked in change rooms or wearing shorts in summer. The scars have attracted attention and caused embarrassment on a number of occasions, including in the workplace. The prominent redness of the donor sites faded after approximately three years, and the raised edges of the scars were reduced by the bandages and vitamin E massage oil. The graft sites, however, are now conspicuously pale, with ridging of the skin and an absence of hair. They still attract unwelcome curiosity. Despite the application of vitamin E oil and compression with condoms, the reduction of the scarring on the penis has been much less successful than for the donor sites. Pain persisted in the graft and donor sites for many years after the surgery, but the intensity and frequency subsided with time. I now experience aches and pains only occasionally. However, since the surgery I have also experienced unpleasant or altered sensations, such as itching or tingling, and numbness. These still persist. Apart from this sensory disturbance in the underlying tissue, I have no sensation in the penile skin graft and also large areas of the donor sites. Due to the absence of the dartos fascia, the graft has adhered to the underlying buck's fascia and is not mobile like natural penile skin. The graft has also contracted and is approximately six to eight times thicker than normal penile skin. <h3>Suicide attempt</h3> There was no way that I could have been psychologically prepared for the highly invasive and extreme nature of the reconstructive surgery, and the resulting pain, trauma, and embarrassment. Members of my extended family were still reluctant to believe that I had been injured, as were a number of psychiatrists whom I consulted. A number of these professionals appeared to be biased in favour of circumcision due to their medical training, and told me that my problems were "all in my head." They advised that I should "just get over" my perceived problems and get on with my life. I felt alone and isolated. I also began to view my injury as a result of assault, and I felt that I had been mutilated. These feelings first emerged before the reconstructive surgery, and increased in intensity with the trauma of surgery. Six months after the surgery, I attempted suicide on 7 January 1993. I had concluded that the impact of the circumcision injury on my life was insoluble. With the exception of my parents and close friends, few people were willing to acknowledge the severity of my injury and trauma, and even fewer people wanted to help. I felt as though I was living in a society where circumcision was still beyond criticism and few people were willing to accept the reality that routine circumcision is a harmful and destructive practice. I could not allow myself to be a hypocrite and live silently in a society where unnecessary circumcision was still condoned and practiced. <h3>Legal action</h3> After surviving a suicide attempt, I experienced a fuller appreciation that the cause of my horrendous experiences is unethical and completely unacceptable. I realized that I could not live with myself if I did nothing to prevent the practice of unnecessary circumcision and spare others from enduring what I had suffered. I decided that I was unwilling to remain yet another victim whose silence was taken by society as an affirmation that circumcision is harmless. For several subsequent years, I concentrated on my university studies and tried to resolve the psychological trauma. This was most difficult. Overall, my Bachelor degree was delayed by four years due to the reconstructive surgery and associated trauma. During this time, I also considered the possibility of taking legal action to gain recognition of my injury and provide proof to Australian society that male circumcision is a highly destructive practice. I first sought legal advice from Dwyer Durack in 1994, but felt overwhelmed by the potential emotional trauma and financial expense of my case. Consequently, I did not proceed with an action at that time. In October of 1997, I was finally approaching the final examinations for my degree. Unfortunately, I was also approaching my 24th birthday. This birthday represented the expiry date for the Statute of Limitations for issue of a Writ of Summons against the doctor who circumcised me. I was not psychologically prepared to commence legal action in 1997, but I was determined not to miss any potential opportunity for justice with expiry of the Statute of Limitations. A writ was issued against Dr. Michael Morley in October 1997, based on the failure of Morley to fulfil his duty of care. The Statement of Claim included loss of quality of life, pain and suffering, and special damages that included a psychological component. My solicitor at Slater and Gordon estimated that I might receive between AU $50,000 to $100,000 in compensation. I replied that, after my horrendous experiences, I would accept no less than AU $500,000 and would prefer in excess of AU $1,000,000. The legal action was difficult due to a lack of similar claims and precedents in Australia. An additional disadvantage was that civil cases in Western Australia are determined by a judge only, in contrast to a judge and jury in other Australian states. Western Australia is also the most conservative state with respect to the treatment of sexual issues by the judicial system. For these reasons, I tried to avoid proceeding to trial. My solicitors found my case difficult to research, prepare, and discuss. It was necessary for me to maintain constant communication and an assertive attitude to ensure the progress of my case. I also completed as much of the research and photocopying as possible to assist my solicitors and to minimize costs. In August 1999, my claim proceeded to a pre-trial conference. I interrupted my doctoral studies at Australian National University and returned to Perth for the first conference on 30 August. As the solicitors for the Defendant requested further evidence, two more pre-trial conference sessions were held on 27 September and 2 November. My psychological health and studies suffered due to the time required for gathering additional evidence, the financial cost, emotional drain, and the associated stress and depression. I felt that I was in danger of losing my PhD candidature. A settlement was still not reached at the final pre-trial conference. Not satisfied that the Defendant's solicitors gave my injury due recognition, I directed my solicitor to issue a 24A offer. This offer gave the Defendant one final opportunity to settle before the claim proceeded directly to trial. The terms of my offer were: 1. The Defendant pay the Plaintiff the sum of AU$360,000 plus repayment to the Health Insurance Commission of AU$5,070.40. 2. The Defendant pay the Plaintiff's costs and disbursements of the action up to and including the date of acceptance of this offer, to be taxed if not agreed. 3. The Defendant admit liability. The Defendant accepted this offer in late November 1999. Although my private health insurance fund paid approximately AU$5,000 of my medical expenses, the Defendant refused to recognize or refund this money. Despite the Defendant's agreement to pay costs, I was required to pay approximately half of the legal costs involved. The admission of liability was vital to my sense of victory and vindication. I wanted public acknowledgement that I had been injured by routine neonatal circumcision. This injury was inflicted on me and has deprived me of freedom, liberty, and a normal life. For this reason, I refused to forego my freedom of speech and would not agree to a settlement that included a confidentiality clause, or a clause denying the medical practitioner's responsibility for my injury. <h3>Current status</h3> I am still in a state of shock from my experiences. I am unhappy to have endured such severe injury and trauma due to a surgical procedure that was completely unnecessary. I would never have consented to circumcision if I had received an opportunity to make the choice that was rightfully mine. Since 1999, I have focused on public awareness to help prospective parents be aware that routine circumcision is completely unnecessary and very destructive. My parents would never have consented to my circumcision if this information had been made available to them. Public awareness was most successfully achieved by an article published in Woman's Day, which included an interview with Dr David Brand, the current head of the Australian Medical Association. Woman's Day obtained an unprecedented statement: <div>The Australian Medical Association doesn't advise circumcision for many reasons. They claim the practice can lead to scarring, deformity, severe blood loss, as well as infection. [49]</div> The Australian Medical Association had never previously acknowledged to the public that circumcision could lead to scarring and deformity. <h3>What I would like to see happen in Australia</h3> Routine circumcision is a controversial issue, with no easy solution. I believe that no person has the right to surgically inflict their religious, sexual, or cosmetic preferences on another person. I contend that no parent or adult has the right to inflict medically unnecessary and irreversible surgery on a child. The Australian legal system must address this issue, as it has done for the issue of sterilization of intellectually disabled females (Family Law Council, 1994), for which Court permission is now required by a new division in the Family Law Act. [50] Likewise, Court permission should be required to perform circumcision on a child under the age of 18, or an adult incapable of giving informed consent, unless there is documented proof of the absolute medical necessity for the health of the individual to support the decision to operate without consent. Many people respect an individual's right to engage in unprotected sex with multiple sexual partners, yet maintain a mistaken belief that the risk of disease transmission may be reduced through the forcible removal of a normal and healthy body part from non-consenting babies. This view fails to recognize or acknowledge that it is solely my right to choose the sexual practices that I will engage in, and solely my right to choose which body parts I will retain or discard. It is also solely my right to choose the religious beliefs and cultural traditions I will subscribe to, and again, solely my right to choose which body parts I will retain or discard. Members of some ethnic groups claim that they have a right to dictate the cultural and religious beliefs that their children will adopt. Such views fail to recognize that children are not the property or the chattel of their parents. I contend that children require an opportunity to learn about their cultural heritage and exercise freedom of choice over the beliefs and traditional practices they will adopt. Parents have a duty to protect their children from harmful practices, and no tradition should be enforced by the permanent alteration or disfigurement of the body of an individual who is legally incapable of providing informed consent. As with many issues concerning human rights, it is difficult to convey these messages to society. The public needs to be accurately informed and educated about circumcision and its associated risks and disadvantages. My mother was shocked to learn that the "useless bit of skin" removed from me was actually rich in sensory nerve endings. [51] She now considers male circumcision the equivalent of female circumcision - a cultural practice that the majority of parents in western societies would never contemplate inflicting on their daughters. It would be beneficial to promote public awareness of the similarities in cultural origins and destructive consequences of male and female genital mutilation. I would like also like to see it become unlawful for family doctors and other inadequately qualified individuals to perform circumcision. Only a pediatric surgeon has the necessary expertise and experience to perform surgery on small children and deal with the possible injuries and complications that circumcision can cause. A step in this direction was recently taken in Israel, following the heavily publicized case of glans amputation during a ritual circumcision. [52] The Israeli Health Ministry has agreed to issue a directive to Israeli hospitals, for the first time allowing them to certify doctors to perform circumcisions. [53] It should also be unlawful for surgery of any kind to be practiced without adequate pain relief. Several ethnic groups and a number of medical practitioners have disseminated a primitive, self-serving belief that infants do not experience pain when subjected to circumcision. [54] The extreme pain and distress experienced by infants who undergo circumcision, however, is well documented. [55-56] For the less than 1% of the male population who may require circumcision for genuine medical reasons, [57] adequate pain relief should be provided, both during the procedure and postoperatively. As a means of discouraging the current widespread practice of circumcision without adequate pain relief, laws should be passed to imprison any individual who is guilty of such conduct for inflicting torture and grievous bodily harm. Rebates for circumcision should be limited on the Medicare Benefits Schedule. Rebates should not be given for routine circumcision or any other unnecessary medical intervention. The Australian public health system is currently in financial crisis. Patients with life-threatening conditions are being denied prompt and essential treatment. Public awareness of the human and economic costs of medically unwarranted circumcision, and the resulting injuries and trauma, may assist in changing attitudes towards this unnecessary and harmful practice. <h4>Acknowledgements</h4> I thank Mrs. Kerry Peterson and Dr. George Williams for their assistance with the preparation of my symposium presentation and this manuscript. I also thank all those who were present at the Sixth International Symposium on Genital Integrity (Sydney 2000), where this paper was first given . Their encouragement and support helped me to deliver this most difficult account of my experiences. <h3>References</h3> 1. Szabo R, Short RV. How does male circumcision protect against HIV infection? 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Pediatrics 1967;39(5):774-6. 31. Sterenberg N, Golan J, Ben-Hur N. Necrosis of the glans penis following neonatal circumcision. Plast Reconstr Surg 1981;68(2):237-9. 32. St Margaret's Hospital for Women (Sydney) vs McKibben. Hearing before the Supreme Court of New South Wales, Court of Appeal. BC8701368. 14 May 1987. 33. Gearhart JP, Rock JA. <a href="http://www.cirp.org/library/complications/gearhart1/" rel="noopener" target="_blank">Total ablation of the penis after circumcision with electrocautery</a>: a method of management and long-term followup. J Urol 1989;142(3):799-801. 34. Hanash KA. <a href="http://www.cirp.org/library/complications/hanash1/" rel="noopener" target="_blank">Plastic reconstruction of partially amputated penis at circumcision</a>. Urology 1981;18(3):291-3. 35. Izzidien AY. <a href="http://www.cirp.org/library/complications/izzidien/" rel="noopener" target="_blank">Successful replantation of a traumatically amputated penis in a neonate</a>. J Pediatr Surg 1981;16(2):202-3. 36. Gairdner DM. <a href="http://www.cirp.org/library/general/gairdner/" rel="noopener" target="_blank">The fate of the foreskin: A study of circumcision</a>. BMJ 1949;2:1433-7. 37. Gee WF, Ansell JS. Neonatal circumcision: a ten-year overview: with comparison of the Gomco clamp and the Plastibell device. Pediatrics 1976;58(6):824-7. 38. Gearhart JP, Rock JA. <a href="http://www.cirp.org/library/complications/gearhart1/" rel="noopener" target="_blank">Total ablation of the penis after circumcision with electrocautery</a>: a method of management and long-term followup. J Urol 1989;142(3):799-801. 39. Money J. Ablatio penis: normal male infant sex-reassigned as a girl. Arch Sex Behav 1975;4(1):65-71. 40. Diamond M, Sigmundson K. Sex Reassignment at Birth: Long-term Review and Clinical Implications. Arch Pediatr Adolesc Med 1997;151(3):298-304. 41. Patel H. <a href="http://www.cirp.org/library/procedure/patel/" rel="noopener" target="_blank">The problem of routine circumcision</a>. Can Med Assoc J 1966;95(11):576-81. 42. Gee WF, Ansell JS. Neonatal circumcision: a ten-year overview: with comparison of the Gomco clamp and the Plastibell device. Pediatrics 1976;58(6):824-7. 43. Clark P. On the penis. In: Operations in Urology. New York. Churchill Livingstone; 1985. pp. 107-112. [here, p. 111.] 44. Taylor JR, Lockwood AP, Taylor AJ. <a href="http://www.cirp.org/library/anatomy/taylor/" rel="noopener" target="_blank">The prepuce: specialized mucosa of the penis and its loss to circumcision</a>. Br J Urol 1996;77(2):291-5. 45. Jordan GH. Grafts and flaps in urology. In: Glen JE, Graham SD, Boyce WH, Turner-Warnick R, Brendler CB, et al., editors. Urologic Surgery. Philadelphia. Lippincott; 1991. pp. 1085-97. 46. Jordan GH, Schlossberg SM, Devine CJ. Surgery of the penis and urethra. In: Walsh PC, Retick AB, Vaughan ED, Wein AJ. Campbell's Urology, 4 vols., 7th ed. Philadelphia: W.B. Saunders; 1998. vol. 2. pp. 3316-33. 47. Jordan GH, Schlossberg SM, Devine CJ. Surgery of the penis and urethra. In: Walsh PC, Retick AB, Vaughan ED, Wein AJ. Campbell's Urology, 4 vols., 7th ed. Philadelphia: W.B. Saunders; 1998. vol. 2. pp. 3316-33. 48. Hermans MH. Duoderm E in the treatment of donor sites: a report. Annals of the MBC 1990;3(3):166-9. [September 1990] 49. Stanley D. Shane's circumcision nightmare: I wish I'd never been born. Woman's Day (Sydney, Australia), (1 May 2000): pp. 24-5. 50. A report to the Attorney-General prepared by the Family Law Council. Sterilisation and Other Medical Procedures on Children. Commonwealth of Australia 1994. 51. Taylor JR, Lockwood AP, Taylor AJ. <a href="http://www.cirp.org/library/anatomy/taylor/" rel="noopener" target="_blank">The prepuce: specialized mucosa of the penis and its loss to circumcision</a>. Br J Urol 1996;77(2):291-5. 52. Siegel-Itzkovich J. Baby's penis reattached after botched circumcision. BMJ 2000;321(7260):529. [2 September 2000] 53. Siegel-Itzkovich J. Israel's health ministry ends circumcisers' monopoly. BMJ 2001;322(7277):10. [6 January 2001] 54. Weiss GN, Weiss EB. A perspective on controversies over neonatal circumcision. Clin Pediatr (Phila) 1994;33(12):726-30. 55. Taddio A, Pollock N, Gilbert-MacLeond C, Ohlsson K, et al. <a href="http://www.cirp.org/library/pain/taddio3/" rel="noopener" target="_blank">Combined analgesia and local anesthesia to minimize pain during circumcision</a>. Arch Pediatr Adolesc Med 2000;154(6):620-3. 56. Anand KJ, Hickey PR. <a href="http://www.cirp.org/library/pain/anand/" rel="noopener" target="_blank">Pain and its effects in the human neonate and fetus</a>. N Engl J Med 1987;317(21):1321-9. [19 November 1987] 57. Rickwood AM, Kenny SE, Donnell SC. <a href="http://www.bmj.com/cgi/content/full/321/7264/792" rel="noopener" target="_blank">Towards evidence based circumcision of English boys: survey of trends in practice</a>. BMJ 2000;321(7264):792-3. [30 September 2000] </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Aussie boy's circumcision nightmare darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h3>Legal reforms needed to protect boys from assault</h3> A shameful incident in Bundaberg, Queensland, in 2002 highlights the need for better protection of boys against unwanted interference with their genitals. In this case a Moslem father forced circumcision on his two sons, aged five and nine, against their own wishes, against the wishes of their mother, and in breach of a specific order by the Family Court. The father was separated from his former partner (an Australian woman of indigenous origin), who had sole custody of the boys, but who allowed them to visit him on the understanding that the man's sister would ensure that they were not harmed. He took advantage of this generosity during one stay to race the boys off to a doctor and have their foreskins amputated. Although the case was investigated by the Queensland Police child abuse unit, which sought to prosecute the man for assault, the case was dismissed in the Bundaberg magistrate's court on legal technicalities. The case shows up the shameful state of medical ethics in Queensland. How was it possible to find a doctor to perform this unnecessary and harmful surgery on two normal boys merely because an adult preferred them to be like him? And not an adult with any legal rights over the boys: had the surgeon done his homework, he would have discovered that the father did not have custody of he boys, and that the Family Court had specifically ordered that they were not to be circumcised. That it was possible is partly a tribute to the destructive influence of circumcision advocates like Professor Brian Morris at Sydney University and the maverick Queensland GP Dr Terry Russell. They are forever popping up in the media to urge parents to have their sons circumcised. Russell's own medical practice consists almost entirely of severing the foreskins from baby boys by means of the plastibell device. No medical organization in the world recommends circumcision, and in Australia both the Australian College of Paediatrics and the Australian Medical Association have issued strong statements against the practice How effective is Queensland and Australia law in protecting the bodily integrity of children? In several European countries, including Sweden and Norway, the written permission of both parents is necessary before a doctor can legally perform a circumcision on boys. A simple rule like that in Australia that could have prevented this tragedy. The case also shows up the sexist and discriminatory double standard by which female circumcision is condemned with horror as female genital mutilation while male circumcision is tolerated as a trivial or even beneficial adjustment. Yet Amnesty International defines genital mutilation as the removal of any part of the genital organs. By this definition, these boys are victims of genital mutilation. If these boys had been girls there would be universal outrage and demands for education programs and legal reform to prevent such cases in the future. Why the sexist double standard? Do boys not have the same right to a complete set of genitals as girls? The father's right to practise his religion and culture does not extend to the right to inflict injury or disfiguring bodily alterations on other people, especially if they are defenceless children. In this special report we print a number of items relating to this tragic and disturbing case. Because new charges may still be laid against the man, it is not possible to reveal his name or that of his ex-partner and the boys. <h3> <a id="media" name="media"></a>Report in News-Mail, Bundaberg, Friday 9 August 2002</h3> Dad escapes charges By Tanya Moore A MAN who had his two young sons circumcised without their mother's permission had charges of grievous bodily harm against him dismissed yesterday. The Bundaberg father, who cannot be identified for legal reasons, had his case dismissed when the prosecution revealed they were not ready to proceed. Bundaberg Magistrates Court was told the man had taken the boys to a Bundaberg hospital while their mother was on holidays to have the operation performed on the six- and nine-year-old boys. Defence barrister Tim Ryan said the doctor had no problems with the "routine operation" because both the boys and the father had given their consent. The court was told the father was "sincere in his religious beliefs" that the boys should be circumcised. But the court was also told the mother, who is separated from the man, disagreed with the procedure and had been involved in a Family Law Court matter, which was the centre of the prosecution's case. Prosecutor Senior Constable Wayne Puxty explained to the court that the prosecution was unable to go ahead without the certified Family Law Court documents that were supposed to be supplied by the mother, and requested an adjournment to receive them. But Mr Ryan said the request was "simply outrageous" given the case had been set down for a hearing since May and the documents wanted by the prosecution had been in existence since August 2000. He added his client had not seen his two sons since the charges were laid on October 3 last year as part of his bail conditions and said any further delaying of the case would be a "misuse of the criminal justice system". Acting Magistrate Neil Lavaring rejected the application for an adjournment, which forced Snr Const Puxty to offer no evidence against the father. Outside court, arresting officer Detective Senior Constable Peter Cormack, from the Gold Coast child abuse investigation unit, said police would still be pursuing the case, on which charges could still be laid. <h3>Report in News-Mail, Bundaberg, Saturday 10 August 2002</h3> Cutting anger By Tanya Moore DOUBLE standards allowed two boys to be circumcised without their mother's permission, an outraged Australian health group said yesterday. Circumcision Information Australia spokesman Shane Peterson said the case in which a six- and nine-year-old boy were circumcised by their Bundaberg father, despite their mother's opposition, was "a tragedy". "In European countries the written permission of both parents is necessary before a doctor can legally perform a circumcision on boys", Mr Peterson said. "This rule should be implemented in Australia to prevent such tragedies." Mr Peterson said the case illustrated a double standard whereby female circumcision was condemned as mutilation while male circumcision was viewed as trivial or even a beneficial adjustment. He said the case also highlighted the lack of implementation of the UN Convention on the Rights of the Child by Australian law. The mother of the boys is also angry at what she sees as a double standard on circumcision. "If I had been in this current situation with two daughters who were circumcised by their Muslim father, the Australian public would be outraged," said the woman, who cannot be identified for legal reasons. "Because it is my two sons who have been harmed, few people seem to care." She said her estranged husband had performed the operation during an access visit to the children last year. Grievous bodily harm and unlawful wounding charges were laid against the boys' father, but these were dropped on Thursday when the prosecution revealed they were not ready to proceed with their case. Detective Senior Constable Peter Cormack, from the Gold Coast child abuse investigation unit, said police would still pursue the case, on which charges could still be laid. <h3>Article in Sunday Mail (Brisbane), Sunday 11 August 2002</h3> Mother's fury as boys circumcised by Elissa Lawrence A MOTHER has spoken of her anguish at discovering her two young sons were circumcised without her knowledge. The woman, 27, who cannot be identified, said she was devastated to learn her former partner and father of her sons had arranged for the boys, then aged nine and five, to be circumcised at a Bundaberg hospital last October for religious reasons. The man appeared in Bundaberg Magistrates Court on Thursday facing charges of grievous bodily harm (for the circumcision). The court was told the Muslim man had taken his sons to hospital to have the operations performed while their mother was on holidays and was "sincere in his religious beliefs" that they should be circumcised. The court was also told the mother objected to the procedure and was involved in a Family Law Court matter central to the prosecution's case. But the charges were dropped when the prosecution revealed missing Family Law Court paperwork meant it was not ready to proceed with the case. An adjournment request was denied, forcing the police prosecutor to offer no evidence against the man. Outside court, arresting officer Detective Senior Constable Peter Cormack from the Gold Coast child abuse investigation unit said police would pursue the case and that charges could still be laid. The boys' mother, who now lives on the Gold Coast, said in a statement she believed her sons had been assaulted. "My sons have a right to grow into adult men with intact bodies and choose their own religious and other beliefs", she said. "If I had been in this situation with two daughters who were circumcised ... the Australian public would be outraged. Being of indigenous Australian descent, I understand the importance of freedom of personal beliefs in a multicultural society." Circumcision Information Australia spokesman Shane Peterson said circumcision was a form of mutilation. "For a long time Australia has had a double standard on male and female circumcision", he said. "Female circumcision is illegal yet male circumcision continues to be unregulated. It's morally wrong. An adult is surgically inflicting their religious, cosmetic or sexual preferences on a child. Surgery of any kind is one of the most invasive and high-risk forms of medical intervention possible, and it should always be the last resort. In European countries, the permission of both parents is necessary before a doctor can legally perform a circumcision on boys." <h2> <a id="release" name="release"></a>Media release by Circumcision Information Australia</h2> <h3>Dropping of charges on father who forced circumcision on sons shows double standard on genital mutilation</h3> A committal hearing for charges of grievous bodily harm and unlawful wounding was scheduled in Bundaberg yesterday against a father who forced his two sons to undergo circumcision during an access visit to his family home last year. The father, of Muslim faith, arranged for his sons aged 5 and 9 to be circumcised for non-medical reasons. This was against the expressed wishes of their mother. "Being of indigenous Australian descent I understand the importance of freedom of personal beliefs in a multicultural society", she said. "I believe my sons have a right to grow into adult men with intact bodies and choose their own religious and other beliefs; I am devastated that the father has stolen that opportunity away from my boys." The charges were dropped yesterday as documents from 1998 needed as evidence for the case could not be located. Prosecutor Senior Constable Wayne Puxty explained to the court that the prosecution could not proceed without certified Family Law Court documents that were supposed to be supplied by the mother, and requested an adjournment to receive them. But defence barrister Tim Ryan said the request was "simply outrageous" given the case had been scheduled for a hearing since May and claimed the documents wanted by the prosecution had been in existence since August 2000. He added his client had not seen his two sons since the charges were laid on October 3 last year as part of his bail conditions and said any further delaying of the case would be a "misuse of the criminal justice system". Acting Magistrate Neil Lavaring rejected the application for an adjournment, which forced Snr Const. Puxty to offer no evidence against the father. Outside court, arresting officer Detective Senior Constable Peter Cormack, from the Gold Coast child abuse investigation unit, said police would still be pursuing the case, and charges could still be laid. By arranging circumcision of the boys, the father was in breach of orders by the Family Court, Brisbane. After a long documented history of physical abuse by the father to the mother, the Family Court ruled that the boys would reside with their mother, and she would have the day to day care and control of their welfare and development. Despite the Court's rulings and the issue of protection orders, on a number of occasions the father threatened to abduct the children, force them to undergo circumcision, and accompany him to Turkey. The father tried to fulfil the first part of his threats by applying to the family court for the boys to be circumcised. The mother of the boys said that the man had a history of substance abuse and psychiatric illness, and that the Family Court "justly dismissed his application for my boys to be forcibly circumcised." The mother feared for her family's safety and moved from Bundaberg to an anonymous address in the Gold Coast to escape the father's continued threats and harassment. For her boys' well-being, she preferred that they have no contact with their father. "I only allowed my boys to stay with their father during the recent access visit as his sister agreed she would be responsible for their care and well-being", she said. It seems the mother's trust was misplaced, as the boys' aunt did not prevent the circumcision that went ahead. The mother believes this was due to the family's Muslim faith. "The father always used his Muslim religion as an excuse for his violence", she said. "He treated us as though we were less than human; he saw us as objects or property for him to do with as he pleased. And now he has assaulted and mutilated my two boys in the worst possible way, by cutting off part of their sexual organs and depriving them of future sexual pleasure". The boys are reluctant to speak of their experience, but have expressed that their father misled them to believe they were going to the doctor for an examination. They are very upset that part of their bodies was removed and do not want any contact with their father. Despite the obvious trauma and breach of court orders, the father's barrister argued that the circumcision should be treated as a moral rather than a criminal issue. This has outraged the mother, who is adamant that her sons have been assaulted. "If I had been in this current situation with two daughters who were circumcised by their Muslim father, the Australian public would be outraged. Because it is my two sons who have been harmed, few people seem to care". A spokesman for Circumcision Information Australia, Mr Shane Peterson, said that the case highlighted the lack of implementation of the United Nations Convention on the Rights of the Child by Australian law. "In several European countries the written permission of both parents is necessary before a doctor can legally perform a circumcision on boys. This rule should be implemented in Australia to prevent such tragedies." Mr Peterson also said that the case illustrated the double standard by which female circumcision is condemned as mutilation, yet male circumcision is viewed as a trivial or even beneficial adjustment. "Amnesty International defines genital mutilation as the removal of any part of the genital organs. By this definition, these boys are victims of genital mutilation." <h3>Further comments on multiculturalism</h3> Stricter rules governing consent for non-therapeutic circumcision could have prevented this sad and all too common occurrence. A high proportion of marriages in Australia are between men and women of different ethnic/cultural backgrounds, and the children of such unions cannot be said to belong strictly to one or the other group; this is all the more true in the many cases where marriages end in separation while the children are still young. Children in such situations will eventually decide which (if any) of the parental cultures they wish to identify with, or whether they wish to choose a cultural identity of their own, and we recognize their right to make a free choice. In a multicultural society, freedom of religion means that each individual must have the freedom to adopt his or her own religion and not have it imposed on them. In order to ensure that this right is real, their bodies should be protected from tell-tale and irreversible alterations. Although these children may choose to identify with the culture of one or other of their parents, they are not only members of that culture; they are also Australian citizens who are entitled to the protection of Australian law and custom. Individual determination has a physical as well as a mental dimension. Multiculturalism was intended as a policy to make people from non-English speaking backgrounds feel more at home in Australia; it was never meant as a carte blanche for the retention of customs that Australian society finds abhorrent. In the <a href="http://www.cirp.org/library/legal/Re_J/">United Kingdom</a> and <a href="http://www.circumstitions.com/Sweden.html">Sweden</a> the judicial systems have intervened in instances where Moslem fathers have sought or arranged for the circumcision of boys without maternal consent. In two cases the fathers were convicted, and in one of these cases the father was gaoled for three months. The practitioner who performed the circumcision was also charged with an offence, though acquitted, by the National Board of Health and Welfare. The United Nations Convention on the Rights of the Child and other international treaties which protect the physical and moral integrity of individuals are available at <a href="http://www.arclaw.org/">http://www.arclaw.org</a> <h2> <a id="rej" name="rej"></a>Important British case upholds child's right to physical integrity</h2> <h3>In re J (1999) confirms that child's physical integrity is more important than desires of parent</h3> J was a five-year old boy living in England, born of a mixed marriage. J's father is a Turkish Moslem, his mother is British. The father wanted him brought up as a Moslem and circumcised. The mother did not, and she took the father to court to prevent that from happening. In a landmark decision she won on both issues. Here are some significant quotes from the judgement of Wall J, delivered in England on 6 May 1999. What the judge said Where there was disagreement between those who had parental responsibility for the child, including a local authority exercising parental responsibility under a care order, circumcision was not to be carried out without the leave of the court. The question of the father taking J to Turkey on holiday is, however, linked with the question of his circumcision. If I decide that J should not be circumcised, the question arises as to whether or not the father's family and/or a Turkish court would accept that decision and feel themselves bound by it. The father assured me in evidence that he would respect the English court's decision, however much he might disagree with it, and would not seek to have J circumcised in Turkey. The father also recognised that if J returned from Turkey circumcised that would constitute a clear contempt of the English court. It is, therefore, clear to me that in Islamic law, J is to be regarded as a Muslim. According to Dr Hinchcliffe, circumcision is not mentioned in the text of the Koran, but in the Sunna (the practice of the Prophet Mohammed), which is the second recognised source of law, it is strongly recommended, and sayings from the Prophet himself are cited in support of the practice. J is plainly not in a position to give an informed consent to his circumcision. There is also ... a body of medical opinion which regards both male and female circumcision as invasive procedures involving unnecessary mutilation of the genitals, and which calls for male circumcision to be criminalised, except in the rare cases where it is medically called for. A case can be made for describing ritual male circumcision without any medical need for it as an assault on the bodily integrity of the child; indeed, that is the case which is made in much of the medical literature to which I was referred. If J were to be circumcised this could be carried out as a day case. J would be likely to be unconscious for about 20 to 30 minutes. It would be a painful procedure. The medical benefits arising from circumcision (apart from the three conditions identified by Dr S for which surgery is indicated) are highly contentious. There is a powerful body of medical opinion which puts strongly in issue any suggestion that male circumcision prevents or reduces the risk of urinary tract infection, penile cancer, or sexually transmitted disease. Equally contentious is the suggestion that it reduces the incidence of cervical cancer in women. There is evidence that tissue loss during circumcision removes or destroys the function of tissue which plays an important part in the overall sensory mechanism of the penis, and that there is a consequential loss of sexual sensory pleasure during sexual intercourse. Dr S's view, as a paediatrician, was that circumcision should only be carried out if medically indicated. I should add, in parenthesis, that amongst the documents shown to me was material from an organisation called Norm UK, the aims of which are to provide education about (1) the need to avoid circumcision and (inter alia) (2) about foreskin restoration. Within this material was an article on foreskin restoration which indicates that it is possible, although restoration cannot give back the erotogenic nerves amputated at circumcision. Equally, there was nothing in the medical evidence I read and heard which indicated that J could not be circumcised as an adult. The father simply could not understand the objections to circumcision. It was a means of demonstrating and reinforcing J's relationship with him: they had to be the same. The procedure for a child of J's age carries small but identifiable physical and psychological risks. It is an invasive procedure, which therefore carries with it risks shared by all surgical interventions: pain, bleeding, infection, surgical mishap and complications of anaesthesia. The father did not accept the risks, either physical or psychological, outlined in the medical evidence by Dr S; and I have to say that, despite his obvious sincerity, there was an element of exaggeration in the father's account of his own circumcision (no doubt as a result of the passage of time), and in my judgment he minimises its painful aspects and underestimates the likely effect of the procedure on J. In my judgment, the strained relationship between the parents, and the fact that as a circumcised child J would be unlike most of his peers, increases the risk that J will suffer adverse psychological effects from being circumcised. The disadvantages are that despite the father's passionate defence of the procedure, J may be traumatised by it. Thus, contrary to the father's perception, circumcision may in fact weaken rather than strengthen his relationship with J. Circumcision carries with it the small but definite risks of both physical and psychological harm to which I have referred. Furthermore J, as a circumcised child, would undoubtedly be different from the majority of his peer group. The consequential possibility that he may be picked on or teased by his peers cannot be excluded as a risk. I think that, because of his strong feelings and the passage of time, the father minimises the pain and discomfort likely to be suffered by J if the operation is performed. Circumcision is an effectively irreversible surgical intervention which has no medical basis in J's case. It is likely to be painful and carries with it small but definable physical and psychological risks. Under art 9 [of the Human Rights Act 1999], the father says that his right to manifest his religion in practice includes the right to arrange for the circumcision of his son in accordance with the tenets of his religion. That seems to me plainly correct. It follows that any limitations on that freedom imposed by a court must be (1) as are prescribed by law; and (2) as are necessary in a democratic society for the protection of the rights and freedoms of others - in this case, the rights and freedoms of both the mother and J himself. … I therefore see nothing inconsistent with the proper operation of arts 8 and 9 of the Convention in a decision of the court which, on the particular facts of this case and in the exercise of a judicial discretion, refuses to make a specific issue order permitting J's circumcision, alternatively prohibits the father from causing J to be circumcised. … Equally, given the balance which the court has to strike between the competing rights of the mother, the father, and the child, it does not seem to me that an order prohibiting circumcision in the circumstances of this case could properly be described as discriminatory under art 14. In my judgment, the argument put forward by the Official Solicitor on this point is sound. Circumcision is an irrevocable step in a child's life. Changes of surname, which require applications to the court in cases of disagreement are reversible: circumcision is not. In my judgment, therefore, where there is a dispute between parents or other persons having parental responsibility for a child over the child's circumcision, that dispute should be referred to the court. For all these reasons, there will be no order on the father's application for J to be brought up as a Muslim and there will be a prohibited steps order preventing the father from arranging or permitting J to be circumcised without the leave of the High Court. I propose to invite counsel to agree the precise terms of the order. Order accordingly. Leave to appeal granted. Re J (child's religious upbringing and circumcision) FAMILY DIVISION, Judge WALL J. 2, 3, 4 MARCH, 6 MAY 1999 Justice Wall's decision was confirmed on appeal. <a href="http://www.cirp.org/library/legal/Re_J/">The full text of the judgement</a> <h2> <a id="muslim" name="muslim"></a>The truth about Muslim circumcision practices</h2> Although the father in the Bundaberg case, and his barrister, tried to excuse his actions by reference to the Moslem religion, Islam does not impose an obligation on parents to circumcise their children. Furthermore, its recommendations about circumcision apply to women as much as men. The Koran, the Moslem bible, makes no mention of circumcision at all, but the prophet Mohammed is reported to have stated that "Circumcision is a sunnah for the men and a makrumah for the women". (Note the reference to men and women: nothing about boys and girls.) The term sunnah means customary or traditional; the term makrumah means meritorious. The most you could conclude is that circumcision was customary for men and meritorious for women, and thus desirable for both but obligatory for neither. In these respects Islam is quite different from Judaism, which requires the head of the household not only to circumcise his baby sons at eight days, but also his male servants and employees, which makes no mention of women in this context, and in which the rule of circumcision is stated prominently in the first book of the Jewish bible. Mohammed further laid down five rules for Moslem men: shaving the pubic hair; circumcision; trimming the moustache; plucking the hairs from the armpits; and clipping the nails. These constitute the fitrah, or laws of personal deportment, to which a pious man in pursuit of perfection must conform. According to Sami Aldeeb, "They are not compulsory, but simply advisable". The vital point about this list is that circumcision is a recommendation for adult men, perhaps no more important than trimming their moustache or shaving their pubic hair. It is thus less obligatory than the rule of prayer five times a day, the pilgrimage to Mecca, fasting at Ramadan or abstention from alcohol and pork. There is certainly nothing in the fitrah which requires a father to circumcise his children. Before assuring the Bundaberg magistrate's court that the man in this case was "sincere in his religious beliefs", his barrister should have established that he scrupulously observed all these requirements, not just the observance that his sons, rather than he himself, had to pay for. There is no unanimity among Islamic theologians as to whether Mohammed himself was circumcised and how it happened. Some say that he was born without a foreskin, others that he was circumcised by an angel or his grandfather. It is thus obvious that, whatever traditions may have evolved in particular cultures over the centuries, Islam does not require parents to have their boys and girls circumcised; and that parents who do have them circumcised cannot appeal to rules of their religion as a justification for this assault. Some Moslems even question whether circumcision itself is necessary and suggest it was merely a custom taken over unthinkingly from desert Arabs when Islam arose in the seventh century. The Egyptian Dr Nawal El-Saadawi writes: "If religion comes from God, how can it order man to cut off an organ created by Him as long as that organ is not diseased or deformed? God doe not create the organs of the body haphazardly without a plan. It is not possible that He should have created the clitoris in woman's body only in order that it be cut off at an early stage in life." As a woman and a victim of circumcision herself, she was referring to the female genitals, but the point is equally applicable to the male foreskin - the part of the penis removed by circumcision. References Sami A. Aldeeb Abu-Sahlieh, <a href="http://www.nocirc.org/symposia/fourth/aldeeb.html">Jehovah, his cousin Allah and sexual mutilations</a>, in George C. Denniston and Marilyn Milos (eds), Sexual mutilations: A human tragedy, New York, Plenum Press, 1997 Dr Sami Aldeeb, <a href="http://www.cirp.org/library/cultural/aldeeb1/">To mutilate in the name of Allah or Jehovah: The legitimation of male and female circumcision</a> Medicine and Law, Vol 13, No 7-8, 1994, pp. 575-622 Also available at <a href="http://www.quran.org/CIRCUMCISION.HTM">http://www.quran.org/circumcision.htm</a> <a href="http://www.fgmnetwork.org/samialdeeb/">http://www.fgmnetwork.org/samialdeeb/</a> <a href="http://go.to/samipage">Dr Aldeeb's home page</a> Sami A. Aldeeb Abu-Sahlieh, Male and female circumcision among Jews, Christians and Muslims: Religious, medical, social and legal debate, Warren PA, Shangri-La Publications (Marco Polo Monographs, No. 5), 2001 <h3>The marsh Arabs: Report by an English traveller</h3> When he was travelling through the marshy region of the lower Euphrates River in the 1930s (present-day Iraq), the British traveller Wilfred Thesiger encountered many Arab people who did not practice circumcision, and others who did and suffered nasty injuries and infections as a result of the operation. His report makes a mockery of the ill-informed statement by the Australian College of Pediatrics (1996) that circumcision "probably originated as a hygiene measure in communities living in hot and dry environments". On the contrary: cutting flesh in primitive conditions was about the least hygienic thing anybody could do, carrying a high risk of bleeding, infection and permanent disability or death, as Thesiger found. Thesiger writes: Circumcision, although nowhere mentioned in the Koran, is generally regarded as obligatory for Moslems following the example of the prophet Mohammed himself, who was circumcised in accordance with Arab custom. No uncircumcised person may lawfully make the pilgrimage to Mecca. Among the tribes in southern Iraq … the operation was often deferred until manhood … and was seldom performed before puberty. It was done by specialists who travelled round from village to village in the summer. Their traditional fee was a cock [!], but more often they charged five shillings. The examples of their work which I saw were terrifying. They used a dirty razor, a piece of string and no antiseptics. Having finished, they sprinkled the wound with a special powder, made from the dried foreskins of their previous victims, and then bound it up with a tight rag. People living under these conditions acquire a remarkable resistance to infection, but they could not resist this, and boys sometimes took two months to recover, suffering great pain in the meanwhile. One young man came to me for treatment ten days after his circumcision, and although I am fairly inured to unpleasant sights and smells, the stench made me retch. His entire penis, his scrotum and the inside of his thighs were a suppurating mess from which the skin was sloughing away, the pus trickling down his legs. I cured him eventually with antibiotics. In spite of the social stigma of being uncircumcised, some boys not unnaturally refused. In other cases the fathers would not allow their sons to be operated on because there was no one else to look after the buffaloes. A few maintained that they had been circumcised by an angel at birth, a superstition that is also current in Egypt. Later I visited villages … where I heard that hardly anyone was circumcised. Wilfred Thesiger, The marsh Arabs, London 1964, pp. 101-2 <h3>Further information on Islamic circumcision</h3> <a href="https://www.circinfo.org/sattouf.html">Riad Sattouf's account of his circumcision as 8-year old in Syria</a> Dr Sami Aldeeb, <a href="http://www.quran.org/CIRCUMCISION.HTM">To mutilate in the name of Allah or Jehovah: The legitimation of male and female circumcision</a> Also available at <a href="http://www.cirp.org/library/cultural/aldeeb1/">http://www.cirp.org/library/cultural/aldeeb1/</a> <a href="http://www.fgmnetwork.org/samialdeeb/">http://www.fgmnetwork.org/samialdeeb/</a> <a href="http://www.quran.org/khatne.htm">A site maintained by Moslems who oppose circumcision</a> </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Abduction and forced circumcision of Queensland boys darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h1>Father’s anguish at circumcision of son</h1> <h3>"Consent procedures for circumcision must be tightened"</h3> A New South Wales father was so distressed at the unauthorised circumcision of his baby boy, and by the bland indifference of the authorities to whom he appealed for justice, that he has set up a <a href="http://www.mycircumcisiondisgrace.org/index.html">website to explain his case</a>. The man, Peter – who wishes to remain anonymous to protect the identity of his son – told Circinfo.org that his 6-week old son was circumcised at his partner’s request while he was overseas on a business trip. But he does not blame his partner nearly as much as the doctor who performed the surgery. “She was a victim of the blatant untruths that are spread to justify circumcision – well-meaning but ignorant. She thought that because I was circumcised I would want the boy to be done, or that all boys were circumcised as a matter of routine. I blame the doctor for three unforgivable omissions: failing to tell my partner that circumcision is very much a minority practice these days; failing to give her a copy of the Royal Australasian College of Physicians policy, which states clearly that circumcision is not widely practiced here, and is certainly not recommended; and, most importantly, for failing to obtain my explicit, written, informed consent as the other parent.” The doctor should also have been aware that the Australasian Association of Paediatric Surgeons recommends that if parents insist of circumcision, it should not be done until the boy is at least 6 months old. The doctor’s failure to seek the consent of the other parent is the nub of Peter’s anger. The <a href="http://www.bma.org.uk/ethics/consent_and_capacity/malecircumcision2006.jsp">British Medical Association</a> insists as a matter of policy that doctors who perform circumcision operations on minors must obtain written authorisation from both parents. In Australia there is no such obligation, but an open slather situation that can easily give rise to tragic situations like Peter’s case, or the <a href="https://www.circinfo.org/bundaberg.html">scandalous affair in Bundaberg</a> in 2004. In that incident, an estranged father who did not even have legal custody of the children, then under the care of the mother, took advantage of a permitted access visit to race the boys (aged 5 and 9) off to a compliant surgeon, who circumcised them on the spot, no questions asked. There was a half-hearted attempt to prosecute the man for assault, but the case was dismissed when his barrister (generously provided by Legal Aid) assured the magistrate that he had acted out of sincere religious conviction. (He was of Turkish origin, and claimed to be a practising Muslim.) There was no attempt to prosecute or even discipline the surgeon for performing an unnecessary operation without valid consent. The case attracted some publicity at the time, but apparently not enough to persuade the medical regulatory authorities that this rule-free situation was placing boys at risk of harm. Disappointingly, there was nothing about the need for a defined consent procedure in the RACP policies issued in 2004 and 2010. If there had been, both Peter and his son might have been spared their respective agonies. “You can imagine my shock and despair when I got home and found what had happened: my beautiful boy with a mangled penis. I had been circumcised – as was the fashion back then – but I had always resented that it was done without MY consent. I hated it, and was determined that my son would not be deprived in the same way. I was looking forward to watching him grow up whole and unblemished. To put it mildly, I was pretty upset when these dreams were shattered.” Peter’s mood was not improved by the indifference and hostility of the authorities to whom he appealed for help. Politicians thought it was none of their business; the Human Rights Commission did not feel that there had been any infringement of the boy’s human rights, nor of Peter’s rights as a parent; bureaucrats advised him that there was nothing they could do; legal authorities informed him – as though they were imparting great wisdom, known only to the select few – that while any form of female circumcision was illegal in most Australian states, circumcision of male minors was perfectly legal, commonly performed and, really, what was all the fuss about? Peter sent three letters to Senator Bob Brown, that doughty champion of the rights of rivers, whales, trees, refugees etc etc, who of all people might have been expected to have some sort of conscience on this issue. He eventually received a reply from a staffer, informing him that the Greens did not have policies on specific medical procedures. Moral vacuity and intellectual inanity “I was dismayed by the intellectually infantile level of the responses, and their moral vacuity. There was not a hint of sympathy, except perhaps from the NSW Commissioner for Children, who said that she did not agree with medically unnecessary circumcision of male minors. Elsewhere there was no suggestion that there were difficult ethical, moral and legal issues here, that required careful thought, not mere catchphrases.” Considering that fewer than 15% of Australian boys are circumcised these days, Peter thought there might have been a constituency that regarded uncircumcised as normal and circumcision as a misfortune, or at least an aberration. “It seems I was wrong”, he admitted. “All I got was apathy, indifference and a sort of mocking incredulity that I should be so concerned with such a trivial issue. The whole experience left me deeply shaken, with a complete loss of faith in the moral fibre of our guardians (politicians, bureaucrats and medical regulators), and even doubts as to their basic competence.” Peter hopes that <a href="http://www.mycircumcisiondisgrace.org/index.html">his website</a> will alert other parents to the appalling loophole in the child protection safety net that would allow any stranger to kidnap a boy in the street, take him to one of the medical practitioners who perform circumcision operations without medical need, and have him done on the spot. “I think that boys ought to have the same level of legal protection against circumcision as girls currently enjoy against mutilation of their genitals. I don’t expect this to happen any time soon, but while we are waiting for the law to catch up with medical ethics I don’t see why boys should have no protection at all. Even dogs have greater protection these days. At the very least, the rules and procedures for circumcision should be tightened up so that outrages like the one that I and my boy experienced cannot happen again.” <a href="http://www.mycircumcisiondisgrace.org/index.html" rel="noopener" target="_blank">Peter's website, My circumcision disgrace, can be reached here</a> <h2>Comment: Open slather on circumcision of boys must end</h2> At a bare minimum, the rules covering non-therapeutic circumcision of male minors ought to include written consent of both parents; proof of identity and of responsibility for the child; where parents disagree, circumcision not to be performed unless ordered by Family Court; signed declaration by parents that they have read and understood the RACP policy statement and a full statement of all the risks and possible adverse consequences (both physical and psychological) of the operation; requirement to watch a video of (a) the circumcision procedure (b) instructions on after-care and handling of complications and (c) appearance and care of the normal (uncircumcised) penis; a cooling-off period of at least 48 hours; operation performed by a fully trained and competent surgeon, with full anaesthesia and post-operative pain control; no rebate from Medicare unless the operation is clinically necessary <h3>Family Court case of K and H: Circumcision may require consent from both parents</h3> Although the authorities to whom Peter appealed for help seemed confident that a single parent’s consent was sufficient to procure the legal circumcision of a child, there is actually some doubt on this question; their certainty may arise from ignorance of the law rather than knowledge of it. A relevant court decision is a judgement of the Family Court in Adelaide in 2003, in the matter of K and H. The case involved the child of a Tanzanian (Muslim) father and an Australian (Anglican) mother; the father wanted the boy circumcised, the mother did not. Their dispute came before the court because the paediatric surgeon consulted by the parents declined to proceed unless both parents agreed to the operation; the father then applied to the Family Court for an order that the circumcision go ahead, while the mother sought an injunction restraining the father from having the boy circumcised. In its judgement the court came down firmly on the mother’s side, and ruled that the child’s best interests required that he not be circumcised, and it issued orders accordingly. An important aspect of the judgement is that it referred to the well-known High Court decision in “Marion’s case”, in which parents sought permission to have their handicapped daughter sterilised. The court held that if parents wanted to perform what it termed a “special medical procedure” on a child, they required permission from the Family Court. The judge in the Adelaide case did not go into the question of whether non-therapeutic circumcision of a minor was also a special medical procedure (some legal authorities <a href="http://www.cirp.org/library/legal/boyle1/">have argued that it is</a>), but he did observe in passing to make another point that “circumcision is a procedure which parents are able to consent to as an aspect of their responsibility.” Note that the reference is to parents (plural). Whether non-therapeutic circumcision of a minor is in fact a procedure to which parents may validly give surrogate consent was not the point being decided here, and the judge’s remark on this is more in the nature of a passing comment than a substantive legal ruling – or in legal terminology, an obiter dictum (thing said by the way) rather than <a href="http://www.alpn.edu.au/node/60">a ratio decidendi </a>(the reason for deciding). What is of permanent legal significance, however, and relevant to Peter’s situation, is that the court went on to make this statement: “The child, of course, is too young to consent to the procedure and it involves an exercise of parental responsibility about which the parents cannot agree. The court must then make the decision.” These words establish a clear legal precedent that the (informed) consent of both parents is required for circumcision of a child for which they are responsible, and that if they disagree the matter must come before the Family Court for a decision. That being the case, any parent who acts unilaterally is potentially in contempt of court, and any doctor who fails to obtain the consent of both parents may be acting unlawfully. Source: Family Court of Australia, Adelaide, 19 December 2003; in the matter of K (father) and H (mother), under Justice Strickland; 2003 FamCa 1364 </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Family Court case of K & H: Legality of circumcision may require consent of both parents darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> The following article by the popular science writer, <a href="http://www.abc.net.au/profiles/content/s2193276.htm?site=science/k2">Dr Karl S. Kruszelnicki</a>, in Sydney's Good Weekend provoked a fierce attack from Australia's leading circumcision crusader, Professor Brian Morris. Circumcision goes back a long way - Egyptian male mummies dating back to 2300BC have been circumcised. Its popularity now varies from country to country - in Australia, between 10 and 20 per cent of newborn males are circumcised each year, compared with more than 60 per cent in the US and less than 2 per cent in Scandinavia. It has long been practised for religious reasons and as a rite of passage in various societies. But there's a (supposed) health issue, too: many parents have circumcised their sons in the belief that it is more hygienic. It's not. As Dr Robert Darby wrote in the <a href="http://www.mja.com.au/public/issues/178_04_170203/dar10676_fm.html">Medical Journal of Australia</a> in 2003, "in the days before aseptic surgery, any cutting of the flesh was the least hygienic thing anybody could do, carrying a high risk of bleeding, infection and death." So how did this myth arise? Wars are very unsanitary, and uncircumcised soldiers were thought to be at risk of serious infection around the foreskin if they couldn't wash frequently. This claim was made in the First and Second World Wars, as well as in both Gulf Wars. In desert wars, it became known as the "sand myth." Dr Ken McGrath, a senior lecturer in pathology at the <a href="http://www.aut.ac.nz/">Auckland University of Technology</a>, could find no evidence to support it. And Sir Duncan Stout, who wrote a chapter on military medicine in the tome History of the Second World War, did not make any reference to circumcision being used to cure foreskin problems. In fact, his official records claimed the opposite - there was a great reluctance to perform circumcisions because the sand in the Sahara Desert was as fine as flour, and was almost impossible to keep out of clothing and away from the skin. But why remove the foreskin? Dr Paul Fleiss, assistant clinical professor of pediatrics at the University of Southern California Centre, says the foreskin is "a uniquely specialised, sensitive, functional organ of touch." It make proteins that fight bacteria and viruses, and produces a moisturiser that keeps the surface of the glans sensitive, soft and moist. Indeed, it has more <a href="http://www.cirp.org/library/anatomy/taylor/">specialised nerve endings</a> than any other part of the penis, and is as sensitive as the lips of the mouth. When did circumcision become linked to hygiene? Probably during the Victorian era, when it was promoted as a way to desensitise the penis to thwart masturbation, which was thought to cause headaches, paralysis, bed-wetting, insanity, epilepsy, tuberculosis, short-sightedness, criminality and heart disease. The hygiene that circumcision was meant to encourage was, it seems, not physical but moral. As far as personal hygiene is concerned, removing the foreskin to have a cleaner penis makes as much sense as removing the eyelid to have a cleaner eyeball. Karl S. Kruszelnicki, May the foreskin be with you, Sydney Morning Herald, Sydney, NSW, Saturday, 10 January 2004 <h2>Circumcision myths: Readers respond</h2> Good Weekend, 31 January 2004, Your Say Dr Karl Kruszelnicki ignores the massive scientific support for the benefits of circumcision (Weekender, January 10) and instead presents only extremist anti-circ nonsense from the likes of Paul Fleiss. Dr K fails to even mention that make circumcision prevents a raft of diseases in both sexes, as well as sexual problems in men. Bacteria abound under the foreskin,* accounting for 11-fold higher urinary tract infections. The foreskin is, moreover, an "HIV magnet". Its removal may reduce the risk of AIDS, penile cancer and cervical cancer. Professor Brian Morris University of Sydney Editor's note: In 2002 the Paediatrics and Child Health Division of the Royal Australasian College of Physicians reaffirmed its position that there is <a href="https://www.circinfo.org/doctors.html">no medical indication for routine male circumcision.</a> Good Weekend, 21 February 2004, Your Say The letter from Professor Brian Morris criticising Dr Karl Kruszelnicki's article on circumcision, and Morris's claim that it is "only extremist anti-circ nonsense" would best be consigned to the file for academic twaddle. Male circumcision, per se, does not prevent the raft of diseases he lists. Bacteria under the foreskin or anywhere else thrive only because of lack of personal hygiene. As my medico says, the greatest preventive or infection is lots of soap and water.** As for circumcision preventing "sexual problems in men", what bunkum. E. Armstrong Coff's Harbour There is no "massive scientific support for the benefits of circumcision" as Professor Morris alleges in his letter. The only medical reason for it is to treat phimosis (excessively tight foreskin), which affects about 1 per cent of boys.*** With good hygiene there is no increased incidence of HIV-AIDS, penile cancer, cervical cancer or urinary tract infections. The foreskin protects the sensitive glans of the penis and, rather than causing sexual problems, it increases sexual sensation. Dr Ian Arthur GP Sawtell, NSW I am 37, uncircumcised, and have not in my memory had a urinary tract infection or penis/sexual problem due to my well-designed crumpled end bit. We don't remove the appendix just because it may get infected. Why should circumcision be regarded any differently from the practice of female genital mutilation? Gary Daly Mosman <h3>Notes</h3> * <a href="http://www.cirp.org/library/anatomy/cold-taylor/">A recent scientific study of the foreskin </a>published in the British Journal of Urology found that sub-preputial moisture consisted of water, shed skin cells, secretions from the prostate, seminal vesicle and urethral glands, various sterols and fatty acids which protect skin surfaces in other contexts, and a variety of benign bacteria – i.e. bacteria which are either harmless or beneficial. ** Soap may not be such a good idea, especially in babies and boys, as it can easily irritate the glans and inner foreskin layer. It's often better just to use water. <a href="https://www.circinfo.org/alternatives.html">Further information.</a> *** Most cases of phimosis can now be treated without the need for surgery. <a href="https://www.circinfo.org/Treatment_of_phimosis.html">Further information</a>. <h2>Press Council dismisses complaint by circumcision professor</h2> Not content with writing a mere letter to the newspaper, Brian Morris tried to use his status as a professor at Sydney University to pressure the university to sack <a href="http://www.abc.net.au/profiles/content/s2193276.htm?site=science/k2" rel="noopener" target="_blank">Dr Kruszelnicki</a> from his position as Julius Sumner Miller Fellow in the School of Physics. He also filed a formal complaint of bias against the Sydney Morning Herald with the Australian Press Council. But as the following article in the Herald shows, he was not successful in these efforts to suppress free speech. Sydney Morning Herald, Tuesday, 13 April 2004 The Australian Press Council has dismissed a complaint by Professor Brian Morris against the Good Weekend magazine, published by the Sydney Morning Herald, over a column by Dr Karl Kruszelnicki. Professor Morris's complaint centred on a regular short column, Mythconceptions, in which Dr Kruszelnicki writes about 400 words on many different subjects which fall into the category of "life's myths, curiosities and absurdities". In particular, Professor Morris complained about a column on circumcision, "<a href="http://www.cirp.org/news/smh01-10-04/">May the foreskin be with you</a>", published on 7 January 2004, describing it as "a mischievous anti-circumcision" article and "blatantly biased propaganda". He said Dr Kruszelnicki was "deliberately deceptive" in not mentioning any of the health benefits of circumcision and criticised one of Dr Kruszelnicki's sources as an "anti-circ activist" and a "hero of the anti movement" who did not have appropriate medical qualifications. In response, Dr Kruszelnicki, who acknowledged that he is not a urologist,* pointed out that his column did not set out to discuss in detail the pros and cons of circumcision but rather discussed specifically what he saw as "the myth" that circumcision was originally performed for hygiene reasons and <a href="http://www.mja.com.au/public/issues/178_04_170203/contents_170203.html">how this belief later evolved.</a> Dr Kruszelnicki named four sources, including the one objected to by Professor Morris. In relation to the latter, Dr Kruszelnicki pointed out he quoted just eight words from that source: the foreskin is "a uniquely specialised, sensitive, functional organ of touch". The Press Council noted that Good Weekend offered Professor Morris an opportunity to air his views by publishing his letter to the editor on January 31. However, Professor Morris also believed that Good Weekend magazine, in later publishing three letters opposing the views in his letter, demonstrated editorial bias. Given the nature of the Mythconceptions column and the fact that Good Weekend published Professor Morris's letter, the Press Council said it believed the publication had adequately dealt with the matter. * Neither is Brian Morris. </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Dr Karl on the origins of circumcision darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h2>The Wroeites, William Chidley and the British Medical Association: Bizarre sex cults in nineteenth century Australia</h2> <h5>Seminar paper given to History Department, Australian National University, Friday 26 March 2004</h5> <h3>Outline and introduction</h3> The Wroeites were an ascetic millennial sect with a penchant for Old Testament rhetoric and Jewish ritual. William Chidley was a lifestyle reformer who thought he had found the key to human happiness on earth: it could be attained by a revolution in the mode of sexual intercourse. The British Medical Association, promising its own millennium in the form of perfect health, represented the mainstream of orthodox and increasingly scientific medical practice. A central plank of this was the proposition that masturbation was a major cause of organic and mental disease in both men and women, and the single most important cause of spermatorrhoea, impotence and inexplicable wasting illnesses â€“ often referred to as debility â€“ in men. What these three nineteenth century cults had in common is that they placed male sexuality, and more specifically the male genitals, at the centre of their world view and action program. Indeed, it was not just the male genitals, but the penis that was their focus, and in the case of the Wroeites and the BMA, a specific part of the penis known to anatomy as the prepuce, more commonly referred to as the foreskin, or forey, as lucky Queenslanders say. I therefore warn you now that the content of my paper is adult in nature. If you do not wish to hear explicit talk about the male genitals and sexual acts, please don't attend. I cannot claim that this is a particularly coherent or polished paper. It consists of a few bits and pieces hewn from the work I have been doing over the past four or five years on male sexuality, and more particularly on changing attitudes to male sexuality and the male genitals in Britain â€“ and the anglophone world more generally â€“ from the seventeenth to the twentieth century. This began as a more limited project to write an account of the rise and fall of routine male circumcision in Australia, from the late nineteenth century to the 1990s, by which time it seemed as though it was going the way of such valued therapies as bleeding, phrenology and frontal lobotomy. To understand the emergence of circumcision in Australia, however, it was necessary to go back to the British home base, and once I got there I found that the key to the whole question lay in the masturbation phobia â€“ a phenomenon which reached its peak in the late nineteenth century, but which had its origins in the late seventeenth, and even before then in Jewish and Christian religious teaching. After that, among other finds, I discovered the importance of syphilis and the purity movement. In this way my intended introduction on the British background grew into a book in its own right which, I hope, is to be published by an American university press some time next year. What these cults further had in common was a tendency to pathologise male sexuality as a major source of physical, mental and moral decay, and in this they were part and parcel of the Victorian construction of sexuality as a nest of problems, very different from the generally positive attitudes which had prevailed in the Georgian age. Indeed, looking at the evolution of medical knowledge of sexuality over three centuries I found a curious pattern. In the libertine eighteenth century, medical authorities were not much concerned with sex, except in relation to venereal disease, but they knew that most men and women desired sexual relations with each other, that such connections were mutually pleasurable and beneficial to the health of mind and body, that normal genitals required no modifications for optimum function and appearance, and that the foreskin specifically was a valuable feature of the male package. In the nineteenth century they knew that many women did not enjoy sex, and some regarded it with revulsion, that men were governed by animal passions, that sexual activity was always risky and "too much" of it positively harmful, that both the male and female genitals were frequently in need of surgical improvement, that the male foreskin was a menace to both health and morals, and that a host of diseases and social problems were directly related to sexuality. For all their moralism, Victorian doctors were obsessed with sex. And not just doctors, as I hope my three exhibits will demonstrate. I would like to thank Dr Chris Forth for encouraging my research and Professor Frank Lewins for inviting me to be a Visiting Fellow in the School of Social Sciences in 2004. <h3>The Wroeites, William Chidley and the British Medical Association</h3> E.P. Thompson has warned us not to condescend to the poor deluded followers of Joanna Southcott, [1] but it is hard to have much sympathy with the most deluded of them all, the self-appointed prophet John Wroe, founder of the Christian Israelites. Southcott offered a fiery brand of millennial preaching and visions of the Last Judgement, and she attracted a large following in the south-west of England in the 1790s and up until her death in 1814. Hers was one of several millenarian movements which attracted the poor and dispossessed of the Industrial Revolution, and their inspiration was the blood and thunder of Old Testament, and thus the rites and practices of the Jews. They readily identified themselves with the children of Israel, oppressed by the ungodly, but sustained by divine promises of eventual victory and bloody revenge against their modernising enemies, certainly involving a great deal of smiting. John Wroe (1782-1863) was one of Southcott's followers, and after her death he set himself up as a prophet in whom the Judaizing tendencies already apparent were greatly intensified. He began by actually trying to convert to Judaism, but decided to establish his own religion after being rebuffed by the Liverpool synagogue. His own creed was an ascetic regime based on Mosaic Law, including a ban on pork, shellfish, alcohol and tobacco, elaborate rules about dress, the requirement to wear a beard, Sabbath observance and the adoption of male circumcision. Wroe himself was publicly circumcised in 1824, and later that year he circumcised a young convert. Like many evangelists in our own day, he had some trouble with sexual temptation, and he was charged with an offence against a 12-year old servant girl, though acquitted. Later his own followers set up an inquiry into his "indecencies" with three young women of the congregation. It does not seem to take long for an adult who has chosen a bodily alteration like circumcision for himself to try to force it on others, and in 1824 one of Wroe's followers was charged with manslaughter after a boy whom he had circumcised in Bedford died from the wound. Another convert was James Smith (1801-57), known as Shepherd Smith, who wrote an autobiographical account of the sect in which he wrote of himself as follows: He was now a Jew or Israelite bodily and spiritually. ... He kept the law of Moses as faithfully as any modern Jew. He abandoned the use of pork ... or fish without scales. He abandoned even the occasional use of spirits, tobacco or snuff, and adopted all the cleanly, chaste, and orderly habits which were enjoined. [2] The last reference is of particularly interest, suggesting that the adoption of a Jewish lifestyle was another route to the work-focused sobriety of the Protestant ethic: cleanliness, chastity and orderly habits were exactly the values being enjoined on the Victorian middle class at that time, by doctors and clergy alike. Wroeism flourished in the new industrial towns of Yorkshire in the 1820s and 30s, though it is not clear whether all adherents underwent circumcision, and from there emigrants took the new creed to the Australian colonies. The Wroeites did not attract a strong following in the Antipodes, and what I know of them comes from a pamphlet by a regretful convert, with the uncompromising title, The abominations of the Wroeites (or Christian Israelites) fully and completely exposed, published in Melbourne in 1863. [3] The author, Allen Stewart, was an apprentice carpenter who reports that on his Sunday rambles he met "some of Wroe's preachers, listened to their sermons and read their tracts, which gradually worked upon my mind, till I really thought I had met with the best and purest people on earth, who could assuredly show me the way to heaven." To join their society Stewart had to wrote out a full confession of his sins, and then to undergo what he described as "the unpleasant rite of circumcision", in which ordeal he was told that he would be "divinely supported". In the event it did not turn out to be the uplifting spiritual experience he had been led to believe: "I found it to be a terrible operation, which cost me three weeks of agony before I recovered from it". Stewart also reported that the Wroeities practised a strange penitential rite in which the man leaned over a table and confessed his sins, while a woman massaged his buttocks and "private parts". One ex-convert reported to John Milton MD (presumably John Laws Milton, a leading authority on spermatorrhoea) that she "began to manipulate his private parts till he was afraid he would not be able to contain his ... [sic]". This did not happen to Stewart himself, and the ritual seems oddly at variance with the ascetic trend of the cult; it may be that he was retailing hostile gossip rather than giving an accurate description of its practices. Calling himself a fool and madman to get involved with the sect, Stewart concluded with a warning to parents: Remember that your children ... may be deluded by these people, that the atrocities which I have witnessed may be practised upon them â€“ then happy will they be if ... they are rescued ... even [if it is] with a shattered constitution, a shaken mind and life-long remorse. I wonder here whether Stewart was referring mainly to circumcision, or whether it was to the apocryphal masturbatory rite, since the consequences he enumerates â€“ shaken mind, shattered constitution and life-long regret â€“ are exactly the results which, according to nineteenth century doctors, flowed inevitably from that shameful indulgence. Of course, the life-long remorse could just as easily refer to his allowing the amputation of his foreskin. William Chidley I also wonder whether my next exhibit, William Chidley, might have heard a Wroeite sermon in his youth, since in his autobiography he recalls an itinerant preacher asserting that the snake in the Garden of Eden was really an erect penis. It sounds like the kind of comparison an adherent of the cult might have made, and the thought leads me into the program of Australia's best known sex reformer and most famous eccentric. Of all the claims made by Victorian specialists in male sexual problems, the one that seems most improbable to us is that men were troubled by erections. That some Victorians did find their erections a source of anxiety rather than pride, and actually sought means to discourage them, as though they were a malfunction like toothache, is a tribute to the doctors' success in convincing the public that normal male sexuality was a chronic disease. An extreme case was William Chidley (1860-1916), whose sad life might be used to illustrate many morals, including Pope's warning that a little learning is a dangerous thing. After reading a pamphlet on the dangers of masturbation as a teenager he became convinced that all his subsequent health and personal problems were the result of self-abuse. When he grew up he learned from William Acton and other standard works on sexual physiology that excessive intercourse could have the same effect, and he embarked on a vigorous personal crusade to practise continence and encourage it in others. Eventually he became convinced that erections themselves were the problem and wrote pamphlets in which he advocated what he called "natural coition" â€“ that is, with a flaccid penis which was sucked by vacuum force into the vagina. Attempting to sell these ideas in the streets of Sydney between 1912 and 1915 he was gaoled repeatedly for indecency and eventually confined in a mental hospital. Chidley's views were only a slight extension and distortion of the medical mainstream, and his advocacy of sexual restraint â€“ he would permit sexual intercourse only for a couple of months each year, during Spring â€“ were very much in tune with both medical and theological orthodoxy. But he caused offence by his social origins (an itinerant labourer), by talking about sex explicitly in public, by intruding into a domain that doctors considered their own, and by wearing a toga-like tunic which magistrates judged obscene. Chidley has been the subject of some interesting research, but its focus has been the reception of his ideas and his persecution by the authorities, rather than the sources and content of his teachings. [4] The assumption has been that if he was gaoled by the establishment he must have been some sort of progressive or radical, but he invites reinterpretation as an extreme puritan rather than a libertarian, and as an impressionable autodidact who took the teachings of Acton and others all too seriously. [5] Chidley's theories went through three stages of development. First he thought that self-abuse would produce the dire effects predicted in a pamphlet on the harm of masturbation issued by "a medical man in Melbourne" which he read when he was a teenager. This offered the usual line-up of physical and mental ills, including "shattered nerves, madness etc", as Chidley recalled in his autobiography. [6] The pamphlet did not stop him from masturbating, though it naturally caused intense anxiety and guilt which carried over into his later sexual affairs. The second stage was when he went to the public library to learn more about sex and found that there were books on the subject of excessive coition, in one of which he read the following: "There is little or no difference between the results of excessive coition and those of self-abuse". [7] Chidley did not identify the precise source of this quotation, but it could be from any one of many works on sexual physiology published during the nineteenth century. From this point Chidley regarded all health problems, diseases and the effects of ageing itself as caused by excessive indulgence in sexual intercourse, and he claimed to find that by practising restraint his own health and appearance improved markedly. He wrote in his later pamphlets [8] that the shock of coition caused bodily degeneration and Heart disease, paralysis, epilepsy, diabetes, rheumatism, neuralgia, asthma, consumption, madness and â€“ directly or indirectly â€“ all diseases and deformity. And cancer I am convinced. Only men and women who have accumulated the shocks of coition for twenty or thirty years â€“ until they are one mass of perverted functions â€“ have cancer. I am sure from over twenty years close observation, and for the reason mentioned by Acton, i.e. that all these improve on abstinence and get worse on indulgence. [9] Before we laugh at Chidley's naivety, we should remember that doctors as prominent as Simon-Andre Tissot, Claude-Francois Lallemand, Acton and the Australian James Beaney, on the basis of their own lengthy clinical experience and medical expertise, confidently attributed these same ailments to masturbation. During this phase of his life Chidley eagerly sought medical knowledge and studied many standard works on human sexuality, [10] including Acton's Functions and disorders of the reproductive organs, William Carpenter's Principles of physiology, and texts by E.A. Schafer and Michael Foster. [11] From Carpenter and Acton he learnt that "The high degree of nervous excitement which the act of coition involves produces a depression of spirits to a corresponding amount, and the too frequent repetition of it is productive of consequences very injurious to the general health". [12] From Schafer's and Foster's books Chidley learned that protoplasm contracts in response to shock, a principle which he interpreted as authorising his view that the shock of intercourse caused the brain to shrink and facial features to contract. As time went by and shocks accumulated lesions would appear in the brain itself, in the blood and lymph, and in all glands and secretions. The normal waste and repair would become perverted, and either fat or consumption ensue. That is why people get fat or thin after marriage. ... And that is why people get bald and wrinkled and blind and deaf and pigeon-toed and epileptic and criminal and finally mad. [13] Like many discoverers of hidden truths, Chidley believed he had found the master-key to all illness. In the third stage of his theory Chidley decided that the problem was not too much sex but erection itself. In this development he relied heavily on Acton, whom he praised for identifying the harmful results of sexual indulgence and criticised for not taking his insights far enough. [14] Dr Acton's book is full of the evils accruing to our present sexual coition", he wrote. "Acton was "surprised at the improvement in his patients ... when they abstained from coition. ... Had he followed that up he would have made my discovery". [15] Chidley was most interested in Acton's discussion of a major issue in nineteenth century sexual medicine: which was the key factor in the harm of sexual activity? Was it the shock of orgasm to the brain and nervous system, as predicted by the dominant nerve force theory of disease? Or was it the loss of semen from the system, as maintained by the fading but still influential humoral or Galenic paradigm? Acton inclined to the former view, thus giving Chidley the lead he needed to transform shock of orgasm into shock of coition, caused by the erect penis. It was perhaps only a small slide from Acton's shock of orgasm (a nervous spasm affecting the male more severely than the female) to Chidley's shock of coition (a vaguely defined event affecting both male and female equally), but Chidley was a trifle dishonest in this particular borrowing from and extension of current sexual physiology. He included two long passages from Functions and disorders, one dealing with debility arising from marital excess, the other with the shock of orgasm/loss of semen problem mentioned above as evidence for his argument. But from both these quotations he omitted crucial phrases which indicate Acton's real concern: the disease of spermatorrhoea, or loss of semen, the cure of which was his specialism. Statements that ill-health was caused by seminal loss were no use to an innovator who wanted to show that the problem went right back to erection in the first place, so the offending and unhelpful text was quietly suppressed. [16] There were two reasons why Chidley rejected Acton's theory that the problem was mere excess. First, there was his failure to define excessive when discussing the harm of excessive intercourse (except retrospectively, after illness had ensued). Secondly there was Chidley's own romantic belief that something as natural as intercourse could not be indulged in to excess, with its implication that there must therefore be something wrong with the method. [17] This consideration might have led him in a libertarian direction, to question the very doctrine that sexual activity was debilitating, but his prior and unshakeable conviction that all illness was caused in this manner sent him further in the other direction. There is a dreamlike quality to Chidley's reasoning in which the ideas he has picked up from his wide reading reappear in grotesque form. Although Chidley was condemned for preaching immorality, he was actually advocating a degree of puritanical restraint even more severe than Acton and all the other moralists who insisted that sex was permissible only for reproduction. He went further to argue that erections themselves were permissible only for reproductive purposes, and that tumescent manifestations in any other circumstances were wrong. Having decided that erections were the root of all evil he was such a sound "Victorian" that he needed to argue that they were unattractive and unnatural as well, and accordingly asserted that the erect penis was "an ugly thing" of which "we are all ashamed" [18] and "a weakness, the same as a stiff neck or knee". [19] It was "an inherited weakness" or lesion, arising from loss of nerve and muscle tone. That erections were also unnatural was proved by the "fact" that "babies and boys have erections", even though they "serve no purpose with boys" and, on the contrary, "may often ruin the boy's life". [20] Conventional medical wisdom was that masturbation ruined a boy's life, so Chidley was only going a little further in blaming the erection which led to the act. Indeed, these comments are remarkably close to the view of Lallemand, who deplored erections before puberty as an unhealthy sign of sexual precocity, likely to give rise to predictable bad habits. [21] Although he had not read Lallemand, Chidley imbibed his suspicion of juvenile penile restlessness through Acton, whose baleful comments on priapism and satyriasis he triumphantly quoted in his pamphlet on erection. He was also impressed by Acton's remark that the principal cause of erection was "nervous irritation" â€“ further evidence of the evil inherent in our mode of coition. [22] Commentators on Chidley have claimed that his views on sexual intercourse were really an attempt to moderate male sexual aggressiveness and "phallocentrism" and thus to increase female pleasure. [23] He did appeal to some "purity feminists", such as Rose Scott and Marion Piddington, who believed that the "double standard" on sexual morality should be evened up by imposing the rule of extra-marital chastity on everybody, but as far as the sexual act was concerned, Chidley took a stricter line than Acton. He had stated that it should be approached cautiously by the strong and be got over with quickly â€“ "some few minutes" only; [24] for Chidley, the only purpose of an erection was to facilitate a rapid ejaculation with a view to impregnation. Going one better than his mentors yet again, he wrote: "there is no reason given why the penis should become erect and then wait. On the contrary, when the erection has reached its full, ejaculation should follow on immediately". [25] The disappointing implications of this scenario for female pleasure hardly need to be stressed. That Chidley was no libertarian is further indicated by his desire to ban alcohol, tobacco and opium, [26] and by the list of perversions he condemned in the course of defending his theory of the unnatural erection. [27] In condemning juvenile and adolescent sex, masturbation, homosexuality, wet dreams and naughty pictures, Chidley was as extreme a Victorian wowser as you could hope to meet. He even advocated the use of chastity devices: Dr Andrew Davidson (a Sydney practitioner to whom he sought to explain his views) reported that he recommended "putting a wire cover over the testicles and penis in order to stop erection". [28] As he told the court during the appeal against his committal for insanity, his aim was not to inflame lust (as the police claimed), but the opposite: "my book lays the axe to the root of all lust". [29] It is important to appreciate how close Chidley was to the medical mainstream, and particularly to the theories of nervous disease then current. Even the doctors who attested his insanity were forced, under questioning, to agree with many of his points. The Chief Government Medical Office (who had certified him) conceded that "sexual excess" was a reality, that it had harmful effects and "a very important bearing on the individual and society", and that it could be a factor in the genesis of general paralysis of the insane. [30] Dr J.M. Creed agreed that intercourse could damage the nervous system because orgasm caused "a brainstorm" and "nervous shocks in high degree"; he added that "nerve disturbance consequent upon coitus might lead to heart trouble". [31] The superintendent of the Hospital for the Insane, at Kenmore, [32] insisted that Chidley was mad, ridiculed the idea that coition caused shocks to the brain, but agreed that masturbation was a "contributory cause" of insanity, and admitted that he adopted methods to prevent it among inmates "when necessary". [33] Dr George Thompson, a Sydney GP recently arrived from England, went so far as to agree that coition did cause nervous shocks which could lead to exhaustion in the "nervous centres"; that erections were sometimes pathological; and that cancer was caused by irritation â€“ and therefore that violent intercourse provoking irritation in the vagina could indeed give rise to it. [34] If Chidley was mad, it was a very fine line that divided him from the medical professionals who had certified him. Chidley's case exemplifies the truth of the adage that there's nothing worse than a reformed smoker/drinker/gambler etc. After a lifetime of exuberant indulgence in sex, alcohol and meat (interrupted, it is true, by spasms of guilt) he reached fifty and suddenly decided it had all been a mistake. He then developed an elaborate system of self-regulation aimed at eliminating these evils from his life, and he turned to vegetarianism, temperance and chastity â€“ much to the bewilderment and displeasure of his de facto wife, Ada, who had enjoyed his studly qualities. [35] So far it was a personal theory. But after Ada's death (from kidney failure arising from alcoholism, according to the hospital, though Chidley blamed their sex life) he began to manifest a syndrome identified by Alan Hunt in Governing morals: that those who seek moral regulation of themselves soon want to reform everybody else. [36] He thrashed his adoptive son (Ada's son Donald, then a boy of about twelve) for masturbating and scolded him harshly even for getting erections. [37] His subsequent career as pamphleteer and public speaker was the result of such an obsession, and his treatment of children under his care offers a disturbing glimpse of how he would have liked to order other people's lives. All Victorian doctors condemned sexual excess, but Chidley went one further to blame the ills of humankind on penile tumescence and to assert that the answer to the world's problems lay in its elimination from daily life. In this he was more ambitious than even Big Brother and the Anti-Sex League in Nineteen eighty-four, which aimed merely to abolish the orgasm. Just before he died Chidley wrote that he had endured an unhappy life, but that he knew that all his misery came "from that 'erection' in boys and men". Perhaps he showed greater insight when he added: "Sometimes I think books have been the curse of my life." [38] Donald might well have thought that they had been the curse of his life. Quackery and orthodoxy It is perhaps surprising that Chidley did not cotton on to the strengthening identification of the foreskin as the major risk factor for masturbation, spermatorrhoea, and other sexual problems. As in Britain and the US, the phobia against masturbation was the main driving force behind the introduction of widespread circumcision in Australia at end of the nineteenth century. David Walker has examined the fears surrounding seminal loss and their connection with conceptions of manhood and national development in three important articles [39], but there are several areas in which his studies need to be extended. As Walker points out, nineteenth century medical orthodoxy held that any seminal loss weakened the system, but that masturbation was especially dangerous, partly because it was so easy to do and partly because it was indulged in mainly by the young, who needed all their energies for proper growth and development. [40] He did not, however, pick up the debate over the role of the shock of orgasm, and the whole question of nervous irritation, in this process, and was thus not alert to why Victorian doctors were so keen to target the foreskin. In concentrating on irregular medical practitioners who offered various quack cures for seminal loss and other "private diseases", moreover, Walker leaves the impression that concern with masturbation was a fringe preoccupation and that orthodox practitioners (those trained in medical schools and usually members of the British Medical Association) were less worried by the problem. This is far from the truth: the danger of masturbation was an unquestioned axiom of the regular medical profession, and the quacks were only trying to take advantage of the fears already generated by its own advice and propaganda. Nor is it possible to draw a hard and fast line between the regular doctors and the quacks; the former exhibited plenty of evidence of ignorant faddism and eccentricity, while the latter frequently offered more humane and less damaging treatments. Ineffective they might have been, but when you are dealing with imaginary diseases it is to the advantage of the patient if the cure is not too heroic. I shall deal with each of these points in turn. The views of the quacks were little different from those of the mainstream medical profession, though they did tend to be cast in more lurid language. Two of Sydney's most prominent specialists in the "nervous and private diseases" of males, Drs Freeman and Wallace, referred to masturbation as a "pernicious habit" which caused a whole brood of diseases, a "disgusting subject", a practice alarmingly widespread among the young, and a problem which must be overcome; their own cures (not detailed in the publicity) were always efficacious in this respect. [41] Even more colourful language was employed by another practitioner, Dr W.B. Towle, who mixed moral and scientific condemnation in a manner typical of the period: The general effects of seminal weakness, nocturnal and diurnal emissions, impotence and sterility, caused by self-abuse in early life, or excessive indulgence in later years, if not relieved by appropriate and thorough treatment, are most deplorable. This malady is one of the most widespread and destructive experienced by man. Few, except physicians, have any conception of the prevalence of self-abuse, or of its disastrous effects on both mind and body. This habit, according to the experience of the most renowned medical men, degrades man, poisons the happiness of his best days and ravages society. ... Many maniacs owe their loss of reason to no other cause. In the tabulated reports of every lunatic asylum are a great number of cases in which the cause of insanity is set down as "masturbation". [42] Given their generally more hellish scenarios, you might think that the quacks would be more enthusiastic about the heroic approach to male sexual problems, and masturbation specifically, than the regular doctors. In fact, the reverse is true: it was the mainstream professionals who favoured modern scientific methods of treatment, such as mechanical restraint, infibulation of the foreskin, cauterisation of the urethra and circumcision. The remedies proposed by the quacks were altogether gentler and less punitive. Freeman and Wallace did not recommend circumcision for any genital complaint and discouraged it even in cases of phimosis; as they reassured nervous clients: "Slitting the foreskin or circumcision is frequently adopted by some surgeons, but we never resort to such measures unless ... absolutely necessary". [43] They made their own attack on quacks who offered fake cures, especially cauterisation of the urethra with caustic substances such as silver nitrate, a treatment recommended by Acton and widely practised by orthodox professionals. [44] Freeman and Wallace were vague about their own methods, but not Dr Towle: he specialised in electro-therapy, offering a range of electrical appliances designed to cure female complaints, liver and kidney problems, joint disease, nervous debility and impotence. The "Hercules Life Renewer" could even treat self-abuse successfully, though in cases where spermatorrhoea was also present, supplementary remedies would be required. [45] There is not a word here about surgical intervention. Indeed, if published testimonials from successfully treated patients may be believed, there is evidence that some men resorted to quacks precisely to avoid the surgical remedies proposed by regular physicians. Towle quotes the example of a young man suffering from paraphimosis: A surgeon had told him he would have to undergo an operation; that the prepuce would have to be cut through. Shrinking from this prospect he decided to consult me. I administered at one some medicine, the effect of which was to relax the constricted muscles ... [and] the patient awoke to find himself quite well. He wrote saying: "I am doubly grateful to you for having not only cured me so easily, but for having saved me from having to undergo a surgical operation, which would have been very painful, and would have left its mark upon me all my days". [46] Given this sort of resistance to the operation, it is not surprising that the circumcision lobby learned to target its propaganda at parents rather than the subjects of the procedure. As David Gollaher has commented, the benefits of circumcision were to be enjoyed only by those who were too young to object. For all the embarrassment they caused the regulars, it is thus not so easy to draw a firm line between the quacks and the medical profession proper. The practitioner who diagnosed a case of tinnitus as stemming from masturbation and who treated it by means of electric shocks and a long course of urethral dilation was not a quack, but Dr W.F. Quaife BA, MB etc, who described his cure in the journal of the Australian branch of the British Medical Association. [47] Indeed, the campaign against quackery was part of a wider effort on the part of doctors to establish their own professional standing and assert a monopoly over the management of bodily (and some mental) functions. The mainstream doctors had been vying with the irregular practitioners since at least the 1860s, and one of the main issues on which the struggle was fought was their competence to provide better treatment for "nervous and private diseases". Acton had taken numerous swipes at the quacks, and another significant writer on spermatorrhoea, F.B. Courtenay, had fired a broadside called Revelations of quacks and quackery (1860s) in which he emerged as a crusader against the irregulars, and particularly against their claims to cure spermatorrhoeic and related diseases. In his own work on that subject he expressed the usual views on masturbation but was fairly relaxed about involuntary nocturnal emissions and critical of the cauterisation treatment advocated by Acton and others. He attacked the quacks and deplored the reluctance of the medical profession to take spermatorrhoea seriously, thus driving men into their hands. [48] He was one of the influential English writers whose ideas James Beaney had sought to popularise in Australia back in the 1870s. Beaney's treatise on Spermatorrhoea was explicitly part of a campaign to wrest the treatment of these diseases away from the quacks and vest it with qualified doctors; as he writes in the Preface, it was "designed to lead those who are afflicted by them to abandon the pretentious quacks" and turn to "legitimate and honourable practitioners" like himself. [49] Like Courtenay, he was critical of his profession for its "culpable neglect of one of the most important and serious ... diseases to which mankind is subject", thereby driving "a large section of the community ... into the hands of the vilest imposters". By refusing to take the disease seriously and treat it like any other medical complaint, the profession was in fact responsible for sending "thousands of wretched sufferers ... into imbecility and the madhouse and even the grave". Rejecting the prudish and old fashioned view that medical science was too delicate to be concerned with the genitals, Beaney asserts its claim to management of the whole body: "Are not the functions of the surgeon ... to embrace all the maladies to which the body is liable?", including those afflicting the genitals. His audience here is twofold: he wants to convince the public that victims of spermatorrhoea should seek the help of professionals like him, not patronise the irregulars; but he also wants to persuade his conservative colleagues that they should accept spermatorrhoea as a real and serious disease which demanded their professional attention. Quoting from Copland's Dictionary of practical medicine and other English authorities, Beaney regretted that too few doctors took the problem seriously, thus relinquishing it to the "unqualified empiric", but he was pleased to note that this state of affairs was changing, and that doctors were making amends for their neglect. The nub of the case was that spermatorrhoea was too grave and complex a disease to be treated by anybody except the experts: These several phases of spermatorrhoea require special treatment and suggest the folly of trusting their management to the pretentious charlatans and ignorant quacks who parade their nostrums in the daily journals. The disorder ... is too serious in its character and consequences to be carelessly dealt with. ... the question ... calls forth the highest faculties of the surgeon or physician, and taxes the powers of his art often to their limit (1870, p. 103). Yet the sad fact is that there was very little that even the most conscientious physicians could do about these diseases that would distinguish them sharply from the quacks they so bitterly despised. Their treatments for various forms of spermatorrhoea consisted largely of bathing, exercise, diets and "medicines" like potassium, phosphorous and strychnine; their rivals offered much the same regimen, including the application of electricity. Beaney derided them for making use of an "Electro-Galvanic Vital restorer", apparently forgetting that he himself was an exponent of galvanism and Faradization. [50] There was not much in any of this to grab the attention of the public and persuade it to abandon the irregulars; something dramatic was needed, something that only the medical profession proper could offer, some sort of magic bullet. The years 1881â€“1914 were a crucial period in the emergence of the modern medical profession in Australia. A five-year degree had been introduced at Melbourne University in the 1860s, and Sydney followed suit in 1883; the New South Wales branch of the British Medical Association was established in 1881. The emergence of the profession was largely a process of differentiation; as Milton Lewis and Roy Macleod have shown, doctors were struggling on two fronts: against chemists, druggists and "quacks" for control over health care; and against the friendly societies over conditions of work and fees. [51] Doctors had sought since the 1860s to get legislation which would define and secure their position. Their efforts were opposed as an attempt to gain sectional privilege and knocked back several times, but in 1900 the NSW parliament passed the Medical Practitioners Act, which made it an offence for anybody without recognised qualifications to use a medical title and empowered the Medical Board to debar practitioners on a range of grounds. This victory recognised the new prestige of scientific medicine: as Lewis and Macleod comment, "the orthodox practitioners finally won legislative endorsement because they had established a cultural authority superior to that accorded 'alternative' practitioners", [52] though it might be more precise to say that this legislative sanction created the very categories of "orthodox" and "alternative": before then it had been pretty much a free-for-all. Apart from beating the quacks in the lobbying game, however, it is hard to see what medical achievements underlay the doctors' triumph, though the promise of the new germ theory of disease may have been part of it: in 1899 the Sydney Morning Herald looked forward to the conquest of cancer and even gout. [53] As Herbert Moran's memoirs make clear, however, the moral and even confessional role of the doctor increased along with the growth of his scientific status, [54] and the new scientific spirit did not lead to any immediate questioning of the links which had been drawn between masturbation, immorality and disease. Richard Arthur The case of one of Chidley's respectable defenders, Dr Richard Arthur (1865â€“1932), is instructive. Born in England and educated in Scotland, he settled in Sydney in 1891 and became director of a number of major city hospitals. He lived and practised in Mosman and was an independent member of the NSW state parliament for various north shore electorates from 1904 to 1932 and briefly Minister for Health in the Bavin government in 1927. [55] He inveighed against the deceitful machinations of the quacks, yet he was himself a fervent purity campaigner who wrote numerous pamphlets for the Australasian White Cross League on the necessity of youthful continence; he was a keen practitioner of hypnotism and an advocate of vegetarian diets; he warned boys against the dangers of self-abuse and advised parents to circumcise their sons as a preventive measure. It was only the last point which distinguished him from Freeman et al. Arthur agreed with the quacks that masturbation led to severe physical and mental illness: The seed is a very valuable substance, and if it is drained away continually, all the strength and vigour leave the body. The boy or man who practises this vice becomes stunted in growth and enfeebled in mind. he becomes unfit for games and athletics of any kind, and he is not able to study or devote his attention to any object. ... He may so lower his health that he falls an easy victim to that terrible malady, consumption, or he becomes subject to epileptic fits, or, worst of all, he may so injure his brain that he develops insanity in one or other of its dreadful forms. [56] He did not mention circumcision in pamphlets directed at boys, but in one addressed to adults he advised parents to watch carefully for signs of self-abuse and to consult a doctor immediately if a child displayed "any tendency to objectionable habits". In accordance with the medical wisdom of the day, he added that "this vice in the young is sometimes brought about by the existence of some local irritation ... [and] the operation of circumcision is needed". [57] Arthur was a leading light in the Australasian White Cross League, itself an affiliate of the English organisation of the same name and a direct descendant of the groups that waged the English purity campaign of the 1880s which, among other achievements, pressured parliament to raise the age of consent, restrict the circulation of pornography, ban nude bathing and criminalize mutual masturbation among males. [58] In this capacity Arthur urged moral purity in the young and the strict avoidance of sexual activity before marriage. It was this obsession which led him into disagreement with the quacks, whom he criticised for scaring boys with the claim that even involuntary seminal emissions (such as wet dreams) were harmful and in need of special treatment. He reassured them that "in most cases this emission is not unnatural. It is merely a sort of overflow of the semen, and if it do not occur oftener than once in ten days or a fortnight, there need be no cause for anxiety". If, however, they are frequent or are followed by "languor and depression", the sufferer should "seek the advice of some respectable doctor, who will probably soon cure the condition". [59] Arthur's qualified and reluctant acceptance of nocturnal emissions was a consequence of his insistence on chastity; if adolescents and young men renounced masturbation and sexual intercourse, their pent-up energies would have to find release somewhere, and wet dreams were less harmful than "artificial" stimulation. Arthur appears to have held a pretty low estimate of the average adolescent sex drive: to the modern mind, a teenager needing no more sex than one wet dream a fortnight would be a sorry specimen indeed. The more hot-blooded Philip Muskett was willing to allow boys two wet dreams a week before apprehension need be felt . [60] In summary, then, it was not the quacks like Freeman and Towle who offered circumcision as a cure for masturbation and other male complaints. They offered the medical stock-in-trade of Dr Beaney and his colleagues from the previous generation â€“ bathing regimes, proprietary medicines, electrical devices, special diets etc â€“ but they were reluctant to perform surgical procedures and were losing the right to perform them. It was the university-trained and properly accredited medical practitioners who urged circumcision and other surgical interventions as effective, scientific treatments which embodied the latest advances in modern medical understanding and which they alone could provide, in opposition to and in competition with the fringe practitioners. Some patients might have resorted to quacks expressly to avoid the harsh remedies proposed by the regular physicians. In this context it is possible to see the doctor's campaign against quackery as part of a battle for professional turf, indeed, as part of the struggle to establish their own professional identity, and the circumcision cure as one of the weapons in their armoury. REFERENCES 1. E.P. Thompson, The making of the English working class (Pelican 1968), 13 2. J.F.C. Harrison, The second coming: Popular millenarianism 1780-1850 (New Brunswick: Rutgers University Press, 1979), 144. For the Southcottians and Wroeites generally see Chap 5, esp. 138-52, and Thompson, Making, 420-28; also mentioned in Michael Mason, The making of Victorian sexual attitudes (New York: Oxford University Press, 1994), 136. 3. Allan Stewart, The abominations of the Wroeites (or Christian Israelites) fully and completely exposed (Melbourne: Abbott, 1863) 4. Mark Finnane, "Sexuality and the social order: The state versus Chidley", in What rough beast? The state and social order in Australian history (Sydney, 1982): 192-219; Mark Finnane, "The popular defence of Chidley", Labour History, No. 41 (1981): 57-73; S. McInerney, Introduction to The confessions of William James Chidley (St Lucia, Aust., 1977); G.A. Edwards and Wayne Hall, "The case of William Chidley: A study in psychiatry, morality and lunacy law", Australian and New Zealand Journal of Psychiatry 14 (1980): 133-9 5. Although he was not persuaded by Chidley's theories, Havelock Ellis listened to them without ridicule and sought to encourage his gift for poetic expression. He deplored Chidley's persecution by the authorities, admired his courageous persistence in the face of police harassment, and described him later as "the most original and remarkable figure that has ever appeared in Australia", with the moral potential to be another Socrates. That was certainly going too far: although he called him an ascetic in the mould of Augustine and Bunyan, Ellis seems to have appreciated neither the derivative character nor the coercive content of Chidley's doctrines. See Havelock Ellis, The dance of life (London, 1923): 72-3 6. Confessions: 40. Chidley left a very full account of his life in a revealing autobiography which he wrote during the 1890s. He sent a copy to Havelock Ellis who printed extracts from it in two volumes of his Studies in the psychology of sex, preserved the manuscript and later gave it to the Mitchell Library, Sydney. Apart from its frank account of the author's sexual experiences and fears, it offers a remarkable window into working class life in Australia during the late nineteenth century. The autobiography was published in 1977 as The confessions of William James Chidley, with an introduction by Sally McInerney. Extracts from the autobiography were printed in Ellis's Studies in the psychology of sex (two volume edition, New York, Random House, 1936) as follows: History III, Appendix B to Sexual selection in man, in Vol. 1, Part 3: 246-59; and History V, Appendix to Erotic symbolism, in Vol. 2, Part 1: 260-73 7. Chidley, Confessions: 137 8. Chidley published several editions of a pamphlet setting forth his theories. These are: The answer: A philosophical essay (Sydney, 1912); The answer: An essay in philosophy (Sydney, 1914); The Answer: or the world as joy: An essay in philosophy, Complete edition, with an introduction by Francis Anderson (Sydney, 1915). There is also a typescript version in his papers in the Mitchell Library, Sydney: ML MSS143/6. In addition, Chidley prepared an article called "Erection", which he hoped to get published in the British Medical Journal, but eventually printed as a pamphlet (now very rare): The phenomena of erection (Sydney, n.d. [1916]), copy in Mitchell Library; the TS is in the Chidley papers: ML MSS143/6 9. Answer 1912: 27 10. Chidley could have read all these books at the State Library of Victoria, which still holds numerous works by Carpenter, including his Principles of human physiology (1881); several editions of Beaney's books; three texts by E.A. Schafer (Textbook of physiology (1900), Essentials of histology (1907), Experimental physiology (1912)); and Michael Foster's Textbook of physiology (1888 and 1893 edns). The library does not now hold a copy of Acton's Functions and disorders, but it used to hold a copy of the first edition, now missing. (Information from SLV, 24 April 2003) 11. (Sir) Michael Foster (1836-1907) was the first professor of physiology at Cambridge, and successor to Carpenter as Britain's leading authority on the subject. His Textbook of physiology was first published in 1876. See Oxford Companion to Medicine (New York, 1986): Vol. I, 403 12. Answer 1912: 12. Although Chidley attributes this statement to Schafer, it is actually a quote from Carpenter. 13. Answer 1915: 165, 166-7; see also Confessions 169, where Chidley cites Foster's texts on physiology. 14. Erection: 3-4; MS: 9 15. Answer 1915: 163 16. Answer 1915: 196-7 misquoting Functions and disorders (3rd edn): 125 and 170 17. TS draft of The answer, ML MSS143/6: 83-4 18. Answer 1912: 48 19. Answer 1912: 40 20. Answer 1915: 158 21. Claude-Francois Lallemand, A practical treatise on the causes, symptoms and treatment of spermatorrhoea, trans. and ed. Henry J. McDougall, 3rd American edition, (Philadelphia: Blanchard and Lea, 1858): 135 22. Erection: 3-4; Functions and disorders: 153 23. Finnane, "Popular defence": 68, 72 24. Functions and disorders: 115, 117-18 25. Erection: 2; MS: 4 26. Answer 1915: 196 27. Answer 1912: 50 28. Transcript: 619 29. Transcript: 386 30. Transcript: 519 31. Transcript: 99, 102-3 32. A mental hospital in the country to which Chidley had been transferred to put him beyond the reach of his friends in Sydney. 33. Transcript: 583, 594, 598-9 34. Transcript: 104, 162, 175, 126-7 35. Confessions: 169, 197 36. Hunt, Governing morals 37. Confessions: 249-50, 254 38. Chidley's last message to the public, quoted in Confessions: xiv 39. Walker, David. Continence for a nation: Seminal loss and national vigour. Labour History 1985; No. 48:1â€“14; Modern nerves, nervous moderns: Notes on male neurasthenia. Australian Cultural History 1987; No. 6:49â€“63; Energy and fatigue. Australian Cultural History 1994; No. 13. 40. Walker, David. Continence for a nation: Seminal loss and national vigour. Labour History 1985; No. 48: p. 7. 41. Freeman, Howard and Dr Wallace. Rescued at last: Being clinical experiences on nervous and private diseases. Sydney; No publisher or date of publication [1898?]. Chapter 4, pp. 30â€“51. 42. Towle, WB. The sexual system in health and disease. Sydney; No publisher or date of publication [1898?]. 11th edition. pp. 107â€“8. 43. Freeman, Howard and Dr Wallace. Rescued at last: Being clinical experiences on nervous and private diseases. Sydney; No publisher or date of publication [1898?]. p. 98. 44. Freeman, Howard and Dr Wallace. Rescued at last: Being clinical experiences on nervous and private diseases. Sydney; No publisher or date of publication [1898?]. pp. 199â€“205. 45. Towle, WB. The sexual system in health and disease. Sydney; No publisher or date of publication [1898?]. 11th edition. p. 108. 46. Towle, WB. The sexual system in health and disease. Sydney; No publisher or date of publication [1898?]. 11th edition. p. 161. 47. Quaife, WF. Tinnitus connected with onanism. Australasian Medical Gazette 1896; XV:20â€“22 . Discussed in Walker D. Continence for a nation: Seminal loss and national vigour. Labour History 1985; No. 48: pp. 8â€“9. 48. Courtenay, FB. On spermatorrhoea and certain functional derangements and debilities of the generative system: Their nature, treatment and cure. London: Bailliere, Tindall and Co.; 1882; 12th edition. 49. Beaney. Spermatorrhoea in its physiological, medical and legal aspects. Melbourne: Walker publishers; 1870. p. x. Further references in this paragraph are inserted in the text. 50. Beaney. The generative system and its functions in health and disease. Melbourne: FF Bailliere; 1872. p. 146. 51. Lewis, Milton and Macleod, Roy. Medical politics and the professionalisation of medicine in New South Wales, 1850â€“1901. Journal of Australian Studies 1988; No. 22:69â€“82 52. Lewis M and Macleod R. Medical politics and the professionalisation of medicine in New South Wales, 1850â€“1901. Journal of Australian Studies 1988; No. 22: p. 79. 53. Lewis M and Macleod R. Medical politics and the professionalisation of medicine in New South Wales, 1850â€“1901. Journal of Australian Studies 1988; No. 22: pp. 78â€“9. 54. Moran. Viewless winds: Being the recollections and digressions of an Australian surgeon. London: Peter Davies; 1939. pp. 102, 203â€“6. 55. Australian Dictionary of Biography. Vol 7. p. 103. 56. Arthur, Richard. Purity and impurity. Sydney: Australian White Cross League; n.d. [c.1900]. p. 8. 57. Arthur, Richard. The training of children in purity: A booklet for parents. Sydney: George Robertson; n.d. [c.1900]. p. 15. 58. Hyam, Ronald. Empire and sexuality: The British experience. Manchester: Manchester University Press; 1990. pp. 65â€“71. 59. Arthur, Richard. Purity and impurity. Sydney: Australian White Cross League; n.d. [c.1900]. pp. 10â€“11. 60. Arthur has evidently read his Acton, who had described nocturnal emissions "occurring once every ten or fourteen days" as "in the nature of a safety valve", but that if they were more frequent or "attended by symptoms of prostration" the "patient" should seek medical advice (William Acton. The functions and disorders of the reproductive organs. 6th edition. London: J. and A. Churchill; 1903. p. 105). The more hot-blooded Philip Muskett was willing to allow boys two wet dreams a week before apprehension need be felt: Muskett, Philip. The illustrated Australian medical guide. Sydney: William Brooks; 1903; 2 vols. II, p. 203. </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource William Chidley and the BMA darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h3>Statements by Australian medical authorities</h3> Since the early 1970s Australian medical authorities have consistently urged that male infants and boys should NOT be circumcised. The most recent and authoritative statement was issued by the Royal Australasian College of Physicians in August 2009. This document states clearly: "the RACP does not recommend that routine circumcision in infancy be performed." The full outline statement follows. CURRENT COLLEGE POSITION on CIRCUMCISION The Paediatrics & Child Health Division, The Royal Australasian College of Physicians (RACP) has prepared this statement on routine circumcision of newborn and infant boys for doctors who are asked to advise on or undertake the procedure and to assist parents who are considering having this procedure undertaken on their male children. Circumcision of males has been undertaken for religious and cultural reasons for many thousands of years and it remains an important ritual in some religious and cultural groups. In Australia and New Zealand, the circumcision rate has fallen considerably in recent years and it is estimated that currently around 10-15% of newborn male infants are routinely circumcised. Circumcision is now generally performed with local or general anaesthesia, and when the procedure is undertaken for a medical indication this is usually outside of the neonatal period. When considering routine infant circumcision, ethical concerns have focused on recognition of the functional role of the foreskin, the non-therapeutic nature of the operation, and the psychological distress felt by some adult males circumcised as infants. The possibility that routine circumcision contravenes human rights has been raised because circumcision is performed on a minor for non-clinical reasons, and is potentially without net clinical benefit for the child. Recently there has been renewed debate regarding both the possible health benefits and the ethical concerns relating to routine male circumcision. The most important conditions where some benefit may result from circumcision are urinary tract infections, and in adults HIV infection and cancer of the penis. The frequency of these conditions, the level of protection offered by circumcision and complication rate of circumcision do not warrant a recommendation of universal circumcision for newborn and infant males in an Australian and New Zealand context. After extensive review of the literature the RACP does not recommend that routine circumcision in infancy be performed, but accepts that parents should be able to make this decision with their doctors. One reasonable option is for routine circumcision to be delayed until males are old enough to make an informed choice. In all cases where parents request a circumcision for their child the medical attendant is obliged to provide accurate information on the risks and benefits of the procedure. Up-to-date, unbiased written material summarising the evidence should be widely available to parents. In the absence of evidence of substantial harm, parental choice should be respected. If the operation is to be performed, the medical attendant should ensure this is done by a competent surgeon, using appropriate anaesthesia and in a safe child-friendly environment. 27 August 2009 The policy statement represents the consensus position of the Australasian Association of Paediatric Surgeons, the New Zealand Society of Paediatric Surgeons, the Urological Society of Australasia, the Royal Australasian College of Surgeons and the Paediatric Society of New Zealand. <h4>Previous statements by Australian medical authorities</h4> The Australian Pediatric Association recommends that newborn male infants should not, as a routine, be circumcised. ” Australian Pediatric Association, 24 April 1971 The ACP should continue to discourage the practice of circumcision in the newborn male infant. ” Australian College of Paediatrics, Official statement, 1983 The Australasian Association of Paediatric Surgeons does not support the routine circumcision of male neonates, infants or children in Australia. It is considered to be inappropriate and unnecessary as a routine to remove the prepuce, based on the current evidence available. We do not support the removal of a normal part of the body, unless there are definite indications to justify the complications and risks which may arise. In particular, we are opposed to male children being subjected to a procedure, which had they been old enough to consider the advantages and disadvantages, may well have opted to reject the operation and retain their prepuce. ” The Australasian Association of Paediatric Surgeons, "Guidelines for circumcision", 1996 Royal Australasian College of Physicians statements, 2002 and 2004. The Division of Paediatrics and Child Health, Royal Australasian College of Physicians (RACP) has prepared this statement on routine circumcision of infants and boys assist parents who are considering having this procedure undertaken on their male children and for doctors who are asked to advise on or undertake it. After extensive review of the literature the RACP reaffirms that there is no medical indication for routine male circumcision. Review of the literature in relation to risks and benefits shows there is no evidence of benefit outweighing harm for circumcision as a routine procedure. The policy statement represents the consensus position of the Australasian Association of Paediatric Surgeons, the New Zealand Society of Paediatric Surgeons, the Urological Society of Australasia, the Royal Australasian College of Surgeons and the Paediatric Society of New Zealand. The full text of statements from medical authorities in Canada, Britain and Scandinavia, all of which reject circumcision, <a href="https://web.archive.org/web/20181123084240/http://www.cirp.org/library/statements/" style="font-weight: 400;">are available at cirp.org</a>. <h3>British Medical Association</h3> In its guidelines on circumcision, the British Medical Association takes a stronger and more critical line against unnecessary surgical interventions in children. It lays down the following principles of good practice: <ul style="font-weight: 400;"> <li>The welfare of child patients is paramount and doctors must act in the child's best interests.</li> <li>Children who are able to express views about circumcision should be involved in the decision-making process.</li> <li>Consent for circumcision is valid only where the people (or person) giving consent have the authority to do so and understand the implications and risks.</li> <li>Both parents [<a href="https://web.archive.org/web/20181123084240/http://www.bma.org.uk/ethics/consent_and_capacity/malecircumcision2006.jsp?page=3">Go to reference 4</a>] must give consent for non-therapeutic circumcision.</li> <li>Where people with parental responsibility for a child disagree about whether he should be circumcised, doctors should not circumcise the child without the leave of a court.</li> </ul> The BMA also advises that where a problem exists, circumcision should be the last resort, employed only after non-surgical treatments have been tried and failed: Unnecessarily invasive procedures should not be used where alternative, less invasive techniques, are equally efficient and available. It is important that doctors keep up to date and ensure that any decisions to undertake an invasive procedure are based on the best available evidence. Therefore, to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate. Male circumcision in cases where there is a clear clinical need is not normally controversial. Nevertheless, normal anatomical and physiological characteristics of the infant foreskin have in the past been misinterpreted as being abnormal. The British Association of Paediatric Surgeons advises that there is rarely a clinical indication for circumcision. [<a href="https://web.archive.org/web/20181123084240/http://www.bma.org.uk/ethics/consent_and_capacity/malecircumcision2006.jsp?page=3">Go to reference 5</a>] Doctors should be aware of this and reassure parents accordingly. On the question of consent, the BMA insists that in the case of children, both parents must give their consent, and that it must be in writing. Further, if the child is old enough to express an opinion, his wishes and preferences must be taken into account: The BMA and GMC have long recommended that consent should be sought from both parents. Although parents who have parental responsibility are usually allowed to take decisions for their children alone, non-therapeutic circumcision has been described by the courts as an "important and irreversible" decision that should not be taken against the wishes of a parent. [<a href="https://web.archive.org/web/20181123084240/http://www.bma.org.uk/ethics/consent_and_capacity/malecircumcision2006.jsp?page=3">Go to reference 15</a>] It follows that where a child has two parents with parental responsibility, doctors considering circumcising a child must satisfy themselves that both have given valid consent. If a child presents with only one parent, the doctor must make every effort to contact the other parent in order to seek consent. Summary of consent issues <ul style="font-weight: 400;"> <li>Competent children may decide for themselves.</li> <li>The wishes that children express must be taken into account.</li> <li>If parents disagree, non-therapeutic circumcision must not be carried out without the leave of a court.</li> <li>Consent should be confirmed in writing.</li> </ul> Health benefits of circumcision doubted In relation to circumcision as a prophylactic measure (to reduce the supposed risk of diseases that may be contracted in the future), the BMA warns that there are no agreed "health benefits" in circumcision of children and that doctors must warn parents that medical opinion is divided. There is significant disagreement about whether circumcision is overall a beneficial, neutral or harmful procedure. At present, the medical literature on the health, including sexual health, implications of circumcision is contradictory, and often subject to claims of bias in research. Doctors performing circumcisions must ensure that those giving consent are aware of the issues, including the risks associated with any surgical procedure: pain, bleeding, surgical mishap and complications of anaesthesia. All appropriate steps must be taken to minimise these risks. It may be appropriate to screen patients for conditions that would substantially increase the risks of circumcision, for example haemophilia. Doctors should ensure that any parents seeking circumcision for their son in the belief that it confers health benefits are fully informed of the lack of consensus amongst the profession over such benefits, and how great any potential benefits and harms are. The BMA considers that the evidence concerning health benefit from non-therapeutic circumcision is insufficient for this alone to be a justification for doing it. <h3>Circumcision not relevant to Australian AIDS problem</h3> Circumcision as a response to the AIDS problem in Australia has also been rejected by Australian authorities on AIDS control Circumcision of sexually active adult men has been in the news lately as the latest tactic against the AIDS epidemic in Africa. Many people are wondering if this means that boys in Australia and other developed countries should also be circumcised as a precaution. The answer is No. Africa has unique problems, arising from the fact that AIDS there is a heterosexual epidemic caused by social and political breakdown, poor health services, failure to take action when the disease first appeared, widespread sexual promiscuity, often involving prostitution, and refusal to use condoms. In Australia and the rest of the developed countries, AIDS is not an epidemic at all, but a disease that remains confined to specific sub-cultures â€“ homosexual men and intravenous drug users. Unlike in Africa, there is little or no female-to-male transmission, meaning that the average male is not at risk of the disease. In Australia, nearly all cases of HIV have arisen from anal intercourse among men, intravenous drug-taking (using needles), blood transfusions and surgical procedures. In none of these cases would circumcision have made the slightest difference. Studies in developed countries (such as the British Gay Men's Health Survey) show that the incidence of AIDS is actually higher among circumcised men. [1] In Australia, recent studies have found no difference in the incidence of HIV between cut and uncut men. [2] There is evidence from Africa that men who have unprotected intercourse with an infected female partner have a reduced risk (estimated at 50 to 60 per cent) of HIV if they are circumcised, but this only means that they will take longer to get infected. It certainly does not mean that they have any kind of immunity. Assuming the reduction of risk is 50 per cent, it only means that if an uncircumcised man needs eight sessions of unsafe sex with an infected partner to catch HIV, it will take a circumcised man twelve sessions. Studies in developed countries show that condoms provide a risk reduction of 90 to 95 per cent â€“ without the dangers of surgery, and without losing a valuable body part. Africa unenthusiastic Even in Africa there has been strong opposition to the attempts by (largely American) health bureaucrats to foist an American cultural practice (circumcision of infant males) onto indigenous cultures where, if circumcision is practised at all, it is performed as a cultural ritual around puberty. <a href="https://web.archive.org/web/20181123084240/http://www.cirp.org/library/disease/HIV/myers2008/" style="font-weight: 400;">The South African Medical Journal has been particularly vocal</a>, calling the WHO/UNAIDS program costly, ineffective, a violation of accepted principles of bioethics and human rights, culturally insensitive and smacking of medical colonialism. The real problem is reckless behaviour, not normal human anatomy. You would think that any sensible and ethical health strategy would take anatomy as a given and seek to change behaviour, not attempt to do it the other way around. Protection against HIV could never be a justification for circumcising infants or children, since they are not sexually active and thus not at any risk of contracting the disease â€“ unless through surgery itself (always risky, and a frequent vector for all kinds of infection.) When the boy is old enough to become sexually active, he will also be old enough to learn about safe sex and how to act responsibly in sexual matters. The Australian Federation of AIDS organization has stated that circumcision has no role in the management of HIV in Australia. (Australian Federation of AIDS Organisations, Briefing Paper, 23 July 2007, <a href="https://web.archive.org/web/20181123084240/http://www.afao.org.au/library_docs/policy/Circumcision07.pdf" style="font-weight: 400;">"Male circumcision has no role in the Australian AIDS epidemic"</a>. <h4>References</h4> 1. The British Gay Men's Health Survey 2001 found that 5 per cent uncircumcised men were HIV positive, compared with of 6.1 per cent of circumcised men. The report comments: "If circumcised men are less likely to acquire HIV than men with foreskins, then we should expect fewer of the circumcised men to have tested positive than the men with a foreskin. However, more of the circumcised men had tested positive for HIV (6.1%) than had those with a foreskin (5.0%). This small but significant difference is in the opposite direction than predicted if foreskins are contributing to transmission, and was observed in all ethnic groups and across the age range." David Reid, Peter Weatherburn, Ford Hickson, Michael Stephens, Know the score: Findings from the National Gay Men's Sex Survey 2001 (Sigma Research: University of Portsmouth, 2002), p. 38 <a href="https://web.archive.org/web/20181123084240/http://www.gmfa.org.uk/londonservices/research/index" style="font-weight: 400;">Full text available here.</a> 2. For example, Richters J, Smith AMA, de Visser RO, et al. <a href="https://web.archive.org/web/20181123084240/http://www.cirp.org/library/general/richters1/" style="font-weight: 400;">Circumcision in Australia: prevalence and effects on sexual health</a>. Int J STD AIDS 2006;17:547â€“54 <a href="https://web.archive.org/web/20181123084240/http://www.cirp.org/library/disease/HIV/" style="font-weight: 400;">Further articles available here.</a> The full text of the AFAO statement is printed below <h4>Male circumcision has no role in the Australian HIV epidemic</h4> Australian Federation of AIDS Organisations Inc P.O. Box 51 Newtown NSW 2042 Australia Phone: 61 2 9557 9399 Fax 61 2 9557 9867 Email <a class="__cf_email__" data-cfemail="3b5a5d5a547b5a5d5a541554495c155a4e" href="/cdn-cgi/l/email-protection">[email protected]</a> <a href="https://web.archive.org/web/20181123084240/http://www.afao.org.au/" style="font-weight: 400;">www.afao.org.au</a> Briefing paper, 23 July 2007 Male circumcision has no role in the Australian HIV epidemic Key points <ul style="font-weight: 400;"> <li>There is no demonstrated benefit of circumcision in men who have sex with men.</li> <li>Correct and consistent condom use, not circumcision, is the most effective means of reducing female-to-male transmission, and vice-versa.</li> <li>African data on circumcision is context-specific and cannot be extrapolated to the Australian epidemic in any way.</li> </ul> Background Male circumcision is a surgical procedure that involves the removal of all or part of the foreskin from the head of the penis. It is an ancient practice that has been performed in some cultures for millennia â€“ well before the advent of sterile surgery. [1] It has ritual significance in some cultures, and so its practice may be ceremonial, performed with non-surgical instruments by elders rather than doctors, and without anaesthesia. [2] It is an irreversible procedure. Different cultures have performed the rite at different stages of life: commonly in preadolescence as part of a ritual of becoming a man; sometimes for older adult men as a sign of status; and in more recent history, in infancy. Cultural identity may also be entwined with non-circumcision. [3] In the twentieth century in industrialized countries such as Australia and the United States, circumcision became very popular for reasons that are not clear but do not appear to be directly related to religious or specific ethno-cultural affiliation. This trend was reversed in Australia in the 1980s and 90s due to increased acceptance that circumcision provided no medical benefit. Recent data from three major trials in Africa challenges the notion that it is of no benefit. Adult male circumcision has been found to reduce the risk of acquiring HIV in men by around 55-60% in three randomized controlled studies. [4, 5, 6] These trials were conducted in African countries where HIV is endemic â€“ Uganda, South Africa and Kenya. Heterosexual vaginal intercourse is the predominant mode of HIV transmission in these countries. Circumcision did not provide complete protection against HIV, but researchers concluded that circumcision reduced the risk of HIV acquisition in the study groups. While there were high rates of HIV acquisition in both arms of these studies â€“ the circumcised and the uncircumcised â€“ rates were lower in the former group. [7] Following the release of these trial results UNAIDS and the World Health Organisation held an international consultation to analyse the data and consider policy implications. Mass circumcision programs are being proposed throughout the sub-Saharan region. [8] While consideration is being given to making such programs culturally sensitive, the proposed implementation of male circumcision raises complex moral problems relating to cultural practice, gender equity, informed consent, and the just allocation of limited resources. The Australian epidemic In Australia, receptive anal intercourse is the predominant mode of HIV transmission. There has been some research into whether circumcision status makes a difference in terms of HIV acquired through insertive anal sex, but this research has shown no difference between the two groups. [9] Therefore, circumcision is NOT an HIV risk-reduction strategy for men who have sex with men. (Further research from the Health in Men Study will be reported at the IAS conference in Sydney in July 2007.) Circumcision to reduce HIV risk for heterosexual men in Australia? The USA has a growing heterosexual epidemic and very high rates of circumcision. [10] Circumcision does not prevent HIV â€“ in high prevalence areas it reduced the risk of female-to-male transmission. HIV acquisition rates were nevertheless high in both the circumcised and the non-circumcised groups involved in the trials. The African epidemic There is some division of opinion as to whether circumcision programs should be implemented in Africa. UNAIDS and the World Health Organisation have accepted that the data show a population-level benefit of circumcision. However, there are social and ethical arguments against such programs, such as: <ul style="font-weight: 400;"> <li>A partially effective technology may adversely affect condom use and negotiation.</li> <li>Partial efficacy is a difficult concept to communicate to obtain informed consent.</li> <li>Risk behaviour may increase as a result of perceived invulnerability to infection.</li> <li>Women aged 15-24 are at the greatest risk of HIV acquisition and circumcision and circumcision.</li> <li>programs will not reduce infections in women directly for at least 10-20 years.</li> <li>Circumcision may reduce women's ability to negotiate condom use.</li> <li>Circumcision is a complex cultural practice.</li> <li>Circumcision status may become a marker of HIV status, as circumcision of HIV positive men is not being proposed.</li> <li>Ritual circumcision itself may be a route of HIV transmission.</li> <li>Good penile hygiene (washing under the foreskin) may be as effective in reducing the risk of acquiring HIV and STIs as circumcision in uncircumcised men. [11, 12]</li> <li>Circumcision has a 2-10% incidence of complications.</li> <li>If circumcised men have sex before wound-healing their vulnerability to HIV infection increases.</li> </ul> References 1. Aggleton P. (2007) '"Just a snip"?: A social history of male circumcision', Reproductive Health Matters.;15 (29): 15-21 2. Niang, CI. & Boiro, H. (2007) '"You can also cut my finger": Social construction of male circumcision in West Africa, a case study of Senegal and Guinea-Bissau'. Reproductive Health Matters. 15 (29): 22-32. 3. Ibid. 4. Auvert B., Taljaard D., Lagarde E., Sobngwi-Tambekou J., Sitta R., et al (2005) 'Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial. PLoS Medicine, 2 (11) e298 doi:10.1371/journal.pmed.0020298. 5. Gray H., Kigali G., Estrada D., et al. (2007) 'Male circumcision for HIV prevention in young men in Racial, Uganda: a randomised trial', Lancet, 369:657-66. 6. Bailey C., Moses S., Parker CB., et al. (2007) 'Male circumcision for HIV prevention in young men in Kyushu, Kenya: a randomised controlled trial', Lancet; 369: 643-56. 7. The incidence in circumcised men was 0.7-1.0 per hundred person years. 'Male circumcision for HIV prevention: Research implications for policy and programming WHO/UNAIDS technical consultation 6-8 March, conclusions and recommendations' (excerpts). (2007) Reproductive Health Matters, 15 (29): 11-14:12. 8. 'New data on male circumcision and HIV prevention: policy and programme implications', (2007) WHO/UNAIDS. http://data.unaids.org/pub/Report/2007/mc_recommendations_en.pdf 9. Grulich, A,, Hendry, O., Clarke, E., Kippax, S., Kaldor, J. (2001), 'Circumcision and male-to-male transmission of HIV', [Research letter] AIDS; 15 (9):1188-89. 10. Of the estimated 665 million men worldwide who are circumcised, 13% are men living in the USA who are neither Muslim nor Jewish, see Hankins, C. (2007) 'Male circumcision: Implications for women as sexual partners and parents', Reproductive Heath Matters; 15 (29): 62-67. 11. O'Farrell, N., Morison, L., Moodley, P., Pillay, K., Vanmali, T., Quigley, M., et al. (2006) 'Association Between HIV and Subpreputial Penile Wetness in Uncircumcised Men in South Africa', JAIDS Journal of Acquired Immune Deficiency Syndromes, September; 43(1): 69-77. HIV prevalence among uncircumcised men without penile wetness was close to that of circumcised men (42.9%). 12. Hankins, Op Cit: 62. <h3>African health crisis is not an argument for circumcision in developed countries</h3> "Ex Africa semper aliquid novi", said the ancient Romans, "always something new out of Africa". So it is today, when we hear nothing but bad news from the dark continent â€“ drought, disease, war, famine and now circumcision. After many years of fruitless endeavour and an expenditure running into hundreds of millions of dollars, evidence has finally come to light that in Africa men who have unprotected intercourse with HIV positive partners are less likely, or will take longer, to become infected with HIV if they have been circumcised. The protective effect is estimated at 50 per cent, meaning that if it takes an uncircumcised man eight sessions of unsafe sex to get infected, it will take a circumcised man twelve sessions. How this rather limited protection justifies talk of a "vaccine", or authorises circumcision of sexually inactive â€“ and thus not at risk â€“ infants and boys, is not at all clear. The media hype surrounding the results of the clinical trials [1] on which these conclusions are based have been out of all proportion to their real significance. The point to remember is that the developed world is not Africa, which faces such a crisis situation (poverty, poor levels of health and education services, very high levels of HIV infection and of prostitution etc) that resort to desperate measures is understandable. There is no such crisis in developed countries, where HIV has been successfully managed and is confined to specific sub-cultures (homosexual men, especially those who take the passive role in anal intercourse, to whom being circumcised will be no help at all), intravenous drug users (ditto) and immigrants from ... well, Africa. You would not know it from the media coverage, but the World Health Organisation/UNAIDS are not recommending indiscriminate circumcision, but only that circumcision be offered as a preventive option to high risk groups in Third World countries where other (more effective) means of protection (such as safe sex education, fidelity, abstinence and condom use) seem to be impossible to achieve). Who is at risk? Infants and children, especially in the developed world, are not an at-risk population because they are not sexually active. You might argue that it is better to take away a boy's foreskin now than to see him contract AIDS at some unknown date in the future â€“ and who would disagree? But the argument is valid only if circumcision were the only way to avoid AIDS and if it were pretty certain that he would get AIDS if he were not circumcised. In fact, the main risk factor for AIDS is not the foreskin, but unsafe sex; the best, cheapest and most certain way to avoid this easily avoidable disease is not to engage in unsafe sex practices and to avoid sex with partners likely to be HIV positive, such as prostitutes, casual sex workers and the generally promiscuous. There is plenty of time to get this message across to boys before they become sexually active. Prostitution a bigger problem than anatomy The prevalence of prostitution is a major factor in the spread of heterosexually transmitted AIDS, yet government agencies have been extremely reluctant to regulate the sex industry or restrict the activities of the prostitutes in any way because such action might infringe their civil or human rights. At the same time, they have recommended widespread circumcision of male infants and boys, whose own civil and human rights are thus treated as non-existent or of no account. It is of interest that in Senegal, one of the few African countries where the AIDS threat was faced early on and efforts were made to regulate the sex industry and ensure that prostitutes received regular health checks, the incidence of HIV infection is only around 2 per cent, compared with 30 or 40 per cent in places such as Tanzania or Botswana. (For Senegal, see Martin Meredith, The State of Africa: A History of Fifty Years of Independence (London: Free Press, 2005), p. 367.) The sad fact is that little boys are an easier target. <a href="https://web.archive.org/web/20181123084240/http://www.plosone.org/article/fetchArticle.action?articleURI=info:doi/10.1371/journal.pone.0000543" style="font-weight: 400;">Further information on prostitution</a> As Philip Setel has shown in A Plague of Paradoxes: AIDS, Culture and Demography in Northern Tanzania (University of Chicago Press, 1999), there is a very high incidence of prostitution, of various kinds, throughout sub-Saharan Africa, and a very high incidence of HIV infection among the prostitutes. (<a href="https://web.archive.org/web/20181123084240/http://www.historyofcircumcision.net/templates/pages/aids_and_society_in_tanzania.html" style="font-weight: 400;">See review in Archives of Sexual Behaviour, Vol. 34, December 2005</a>). Africa is not Australia In Africa the problem that circumcision is meant to address is heterosexually acquired HIV through Female to Male transmission via unprotected intercourse. in the West there is negligible F to M infection, and most workers in the sex industry are insistent on safe sex and condoms. In the West, the at risk populations are promiscuous male homosexuals [1] and intravenous drug users. Circumcision will not affect HIV transmission in these groups. Western countries such as Australia have low rates of HIV infection because our policies of safe sex education have been successful. What children need to be taught is how to avoid this easily avoidable disease; they do not need, and they do not deserve, to have their natural anatomy forcibly altered. The data from the Africa trials [2] say nothing about the effectiveness of infant or child circumcision, since the trials were confined to sexually active adult men who consented to the procedure. Circumcision does not confer immunity to HIV infection. The level of risk reduction shown (50 per cent) is not sufficient to warrant talk of a vaccine. The protection is not lifelong, and it is far less than the <a href="https://web.archive.org/web/20181123084240/http://www.circinfo.org/news.html#condbest" style="font-weight: 400;">90 per cent protection given by regular condom use</a> and observation of other forms of safe sex. A study of Nigerian prostitutes in 1988 found that, after counselling sessions, condom use increased markedly and that even occasional condom use had a significant protective effect: of 28 women who never used a condom, only eight escaped infection with HIV; but of 50 women who used them in approximately one third of sexual encounters, 27 (54 per cent) avoided infection. [3] It is interesting to compare this with the results of the recent clinical trials of circumcision, which reported a risk reduction of between 50 and 60 per cent: almost exactly the same as the risk reduction achieved by condom use 30 per cent of the time. Despite what enthusiasts for cutting babies say, there is no evidence that circumcision later in life is more risky or harmful than in infancy. On the contrary, all the evidence is that the younger it is done the more harmful, risky and painful it is, and the greater the effects on <a href="https://web.archive.org/web/20181123084240/http://www.cirp.org/library/sex_function/" style="font-weight: 400;">sexual function and sensation</a>. This is because of the tiny size of the organ, ignorance as to the eventual size of the penis and length of foreskin at puberty, the impossibility of safe and effective anaesthetic, and the fact that the neural pathways that learn to transmit pleasurable sensation have not fully developed. If those urging compulsory circumcision of children in preference to optional circumcision of sexually active adult men believe that circumcision in adulthood is so risky, why did they not raise concerns about the dangers of the African circumcision trials, conducted as they were on adults? (Is it the presence of consent that upsets them?) History urges scepticism In the days of the Roman Empire many African peoples already practised circumcision (both male and female) as a cultural ritual. The arrival of imperialism in the form of Roman soldiers and administrators meant that such practices were discouraged as abhorrent to civilized people. Today western medical imperialism is having the opposite effect, spreading circumcision from circumcising to non-circumcising cultures, with the excuse that it is the only measure that can stop the AIDS pandemic. Desperate fears produce desperate reactions, but one wonders how much emotional baggage is bound up in this massive effort. It is interesting to recall that in nineteenth century United States respectable doctors demanded compulsory (legally mandated) circumcision of American Negroes to control syphilis (the AIDS of that era), and even to protect white women from sexual assault. <a href="https://web.archive.org/web/20181123084240/http://www.historyofcircumcision.net/index.php?option=content&task=view&id=63" style="font-weight: 400;">Further details on "Solving the Negro rape problem"</a> <a href="https://web.archive.org/web/20181123084240/http://jme.bmj.com/cgi/eletters/27/6/DC1" style="font-weight: 400;">Further information on ethical aspects of prophylactic surgery as a disease control strategy on low income countries</a> References 1. Because AIDS is not a really serious public health issue in the developed world, there is not much research on the difference in rates of HIV infection between circumcised and uncircumcised men in developed countries, but two significant studies (in Britain and the USA) both found a higher incidence of HIV among circumcised men: David Reid, Peter Weatherburn, Ford Hickson, Michael Stephens, <a href="https://web.archive.org/web/20181123084240/http://www.circumstitions.com/HIV.html#gaysurvey" style="font-weight: 400;">Know the score: Findings from the National Gay Men's Sex Survey</a> (London 2001) Laumann, EO, Masi CM, Zuckerman EW. <a href="https://web.archive.org/web/20181123084240/http://www.cirp.org/library/general/laumann/" style="font-weight: 400;">Circumcision in the United States: Prevalence, Prophylactic Effects, and Sexual Practice</a>. Journal of the American Medical Association 1997;277(13):1052-7 2. The clinical trials are, in any case, a bit fishy for several reasons. (1) They were not blind (as they should have been). (2) They were not random, in that the men chose whether to be or not to be circumcised, thus allowing the likelihood that the former group were more cautious than the latter. (3) There is no reason to suppose that the two groups men then had similar sexual experiences: more of the circumcised men might have had more sex with negative partners than the other group, or they might have engaged in less risky sexual practices, meaning that they were less exposed to risk; in these cases you could not know whether it was the differing behaviour or the altered anatomy that conferred the protection. (4) The trials were terminated prematurely, allowing suspicions that the most favourable moment for statistical purposes was chosen. (5) It is common for the early results of clinical trials to be highly and misleadingly positive, inspiring premature optimism. For an analysis of why this is so, see John P.A. Ioannidis, "<a href="https://web.archive.org/web/20181123084240/http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0020124&ct=1" style="font-weight: 400;">Why Most Published Research Findings Are False</a>", Plos Medicine, Vol. 8, 2005, online at [3]. E.N. Ngugi et al, "Prevention of transmission of human immunodeficiency virus in Africa: Effectiveness of condom promotion and health education among prostitutes", Lancet, Vol. 332, No. 8616, 15 October 1988, 887-890. In case it is suspected that the foreskin might have been a factor here, it should be remembered that the vast majority of Nigerian men are circumcised, and that female genital cutting is also common. <a href="https://web.archive.org/web/20181123084240/http://www.sciencedirect.com/science?_ob=PublicationURL&_tockey=%23TOC%234886%231988%23996671383%23456237%23FLP%23&_cdi=4886&_pubType=J&_auth=y&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=36c0b533779b26840c4108cc37d812e9" style="font-weight: 400;">Abstract of Lancet article available here</a>. Further reading Lawrence Green et al, <a href="https://web.archive.org/web/20181123084240/http://www.futuremedicine.com/doi/full/10.2217/17469600.2.3.193?prevSearch=authorsfield%3A%28green%29&searchHistoryKey=193-99" style="font-weight: 400;">Male circumcision is not the HIV vaccine we have been waiting for</a>, Future HIV Therapy, Vol. 2, 2008 Robert Van Howe and J. Steven Svoboda, <a href="https://web.archive.org/web/20181123084240/http://www.medscimonit.com/abstracted.php?level=5&icid=865808" style="font-weight: 400;">Neonatal circumcision is neither medically necessary nor ethically permissible: A reply to Clark et al</a>, Medical Science Monitor, Vol. 14, 2008 </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Medical authorities maintain opposition to circumcision darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h3>Was sand really such a menace to the foreskin? Did lack of circumcision really cripple armies?</h3> The Summer 2007 edition of The Skeptic magazine (Australia) included an article by Brian Morris on the medical benefits of routine circumcision. In the course of this rather aggressive excursus he defended old claims that the origins of ritual circumcision among certain ancient Middle Eastern tribes lay in health problems caused by the accumulation of sand and dust under the foreskin. Attacking an earlier article by David Vernon, he writes: “In attempting to ridicule the notion that circumcision arose in the Middle East to solve problems caused by ‘sand and dust’, Vernon cites an article by Robert Darby, an anti-circ activist. Darby’s claims stemming from ‘medical records’ ‘he analyzed’ are false. Infections, initiated by the aggravation of dirt and sand, are not uncommon under desert conditions, and have even crippled whole armies of uncircumcised soldiers. It is difficult to achieve sanitation during prolonged battle. To contradict Darby, and thus Vernon, a US Army report by General Patton stated that in World War II 150,000 soldiers were hospitalised for foreskin problems due to inadequate hygiene. (28) To quote: “Time and money could have been saved had prophylactic circumcision been performed before the men were shipped overseas” and “Because keeping the foreskin clean was very difficult in the field, many soldiers with only a minimal tendency toward phimosis were likely to develop balanoposthitis”. (28) The story was similar in Iraq during ‘Desert Storm’ in the early 1990s. (29,30) In the Vietnam War men requested circumcision to avoid “jungle rot”. [1] It might seem rather late in the day to offer a response, but since Professor Morris makes an ad hominem attack on me and suggests that my scholarship is spurious, I hope that I may be permitted a reply in which I shall show that his own respect for evidence is not all that it should be. Describing me as “an anti-circ activist” is an ad hominem device to suggest that because I am sceptical of the value and ethics of routine circumcision anything I say on the subject must be rubbish. I have indeed published extensively on circumcision issues, [2] but if that makes me an anti-circumcision activist, Morris can only be described as an anti-foreskin activist whose views demand to be treated with equal skepticism. [3] Referring to my article as cited by Vernon, he places “medical records” and “he analyzed” in inverted commas, insinuating that the records are somehow unreliable and that my analysis is faulty or even dishonest, leading to his triumphant conclusion that my refutation of this claim must be false. Morris does not identify the article, however, which was a peer-reviewed paper published in the New Zealand Medical Journal [4] – precisely an instance of those “good research studies published in reputable international journals” that Morris says Vernon should have cited. My paper relied on scholarly anthropological sources to show that ritual circumcision arose for cultural/religious, not health reasons; and on the medical volumes of the official histories of Australia and New Zealand in the Second World War to prove that balanitis caused by sand under the foreskin was not a problem in the North African campaign, and that, contrary to the “sand myth”, there were no mass circumcision drives to cure it. Does Professor Morris suggest that the authors of the official histories, in which none of the words “balanitis,” “circumcision,” or “foreskin” make a single appearance, were “anti-circ activists” or (horror of horrors) actually uncircumcised men themselves? But what of Professor Morris’s own scholarly standards? Attempting to refute my argument he cites “a US Army report by General Patton”, and lists a series of pages that are supposed to back up his claim. But when you actually check those pages you find that they have nothing to do with sand under the foreskin and fail to provide any support for the argument that Morris wishes to make. For a start he gets the details of the book wrong. It is not a “report by General Patton”, but a multi-author volume in the official history of U.S. medical services in World War 2, edited by John F. Patton MD. [5] Secondly, there are only two occurrences of the word sand in the entire volume (pages 221 and 447), neither of which has anything to do with foreskins or circumcision. The volume scarcely deals with the Middle Eastern or North African (desert) combat theatres, but mostly with the South-East Asian and Pacific theatres, characterized by dense jungles and wet, humid conditions that posed many intractable health problems, affecting many parts of the body, not just the penis. But in those conditions sand and dust were not an issue. There is not the slightest support for his hyperbolic claim that “Infections, initiated by the aggravation of dirt and sand, are not uncommon under desert conditions, and have even crippled whole armies of uncircumcised soldiers.” As for the pages nominated by Morris, let us see what they actually say: Chapter 4, Venereal Disease (John F. Patton) On page 52, in the section on chancroid, Patton notes that “any penile lesion in the presence of a redundant prepuce may present a problem and also invites secondary infection. Phimosis was a common complication of chancroid, and dorsal slits were often necessary, followed by circumcision after the local infection subsided.” He adds that “Higher headquarters sometimes questioned the number of circumcisions performed in the theater,” but insists that “all were performed from medical necessity, and none were done electively.” In other words, Patton was a fervent believer in circumcision and operated whether the soldiers liked it or not. In those days, in the absence of appropriate antibiotics, circumcision might well have been the only possible response to infections of this type. On page 64 Patton simply notes that in the Mediterranean theatre of Operations circumcision was a common treatment for venereal disease and associated phimosis and inflammation (balanitis). Chapter 6: Infections and Related Conditions (Charles Montgomery Stewart) On page 100 under the heading “Balanoposthitis” (inflammation of glans and foreskin) Stewart notes that lack of cleanliness can lead to irritation, ulcers, and infections. “Treatment requires prompt, regular, strict personal cleanliness and local hygiene. Irrigations of the preputial sac are necessary if the foreskin cannot be retracted. Early inflammation promptly treated subsides rapidly.” He goes on to suggest that in order “to prevent recurrence, circumcision should be mandatory when the local infection and inflammation have cleared”, but does not report that this was actually done. On page 102, under the heading “Balanitis: Preventive Measures”, Montgomery notes that “During the years 1942-1945, inclusive, 22,709 patients were admitted to Army hospitals for balanitis”. Although this was remarkably small proportion of the 13 million men enlisted in the U.S. army during World War 2, he went on to recommend routine circumcision as a prophylactic measure – though it is not clear whether he meant army personnel only, or the entire population. On page 105, Montgomery discusses phimosis (“a congenital or acquired narrowing of the opening of the prepuce”) and notes that “Eventually, the treatment is circumcision,” but warns that “Circumcision in the adult is not the benign procedure it appears to be. These patients are incapacitated from returning to full duty for a minimum of 10 days postoperatively.” He then gives instructions on circumcision technique, warning that “extreme care must be exercised to avoid removal of too much skin. Carelessness may result in partial denudation of the penile shaft. Sufficient preputial skin edge must be left to cover the sensitive papillae of the corona.” In other words, for all his belief in circumcision, Montgomery recognised that because excision of the foreskin could damage the penis you must not remove too much tissue. On page 106 Montgomery notes that during the entire war 110,562 men were admitted to army hospitals for paraphimosis and phimosis and repeats his view that these figures are “so startling” that they “would justify routine prophylactic circumcision.” On page 120 Montgomery discusses venereal warts, discusses topical treatment and notes that “circumcision may be necessary to obtain a permanent cure.” On page 145-6 he continues his discussion of genital warts, and maintains his rage against the foreskin: “Armed forces urological historians should be impressed with the fact that the redundant prepuce again can be pronounced guilty as a consistent contributor to the etiology and high incidence of this disease. Hospital admissions for paraphimosis, phimosis, balanitis, and condyloma acuminatum during the 1942-1945 period totaled 146,793. Had these patients be circumcised before induction, this total would be probably have been close to zero.” As I point out in the discussion below, he provides no evidence that uncircumcised men were significantly more subject to these conditions. His last comment is the fallacy of prediction in hindsight. In Chapter 8, “Genitourinary Neoplasms” (cancer), under the heading “Neoplastic Diseases of the Penis”, Vincent Vermooten notes (page 183): “Carcinomas are so rare in this age group that they call for no comment.” This is also where Morris gets one of his money quotes: “Because keeping the foreskin clean was very difficult in the field [South-East Asia], many soldiers with only a minimal tendency toward phimosis were likely to develop balanoposthitis, and in the presence of venereal warts, inflammation would almost certainly develop,” but the author added that “the use of estrogenic hormone in plastic operations on the penis aided in the prompt recovery of these patients.” Chapter 18, “Reflections” by Ormond S. Culp and John F. Patton, is where Morris finds his other money quote: “During 1942-1945 almost 150,000 soldiers were hospitalized for medical reasons with phimosis, paraphimosis, and/or balanitis; they were unable to maintain adequate local hygiene under combat conditions. The man-hours lost as a result of circumcisions and adjuvant therapy were costly to the war effort and exasperated the commanding officers. Time and money would have been saved had prophylactic circumcision been performed before the men were shipped overseas.” Comment and analysis It is obvious that the pages cited by Morris, although they contain many hostile references to the foreskin, have no bearing on the origins of circumcision in the Middle East, nor to balanitis or other inflammations among Australian or New Zealand soldiers in North Africa. There is no mention of sand at all. Most of the data comes from South-East Asia, where humidity and jungle parasites certainly were major problems; but if they were problems that especially afflicted the foreskins of the U.S. troops, one wonders how the Japanese coped, not to mention the Thais, Vietnamese and Melanesians, none of whom have ever practised circumcision. How significant are the statistics? A total of 13,104,355 men served in the U.S. military in World War 2. If we assume that half were uncircumcised, the number who experienced problems is small: 22,709 cases of balanitis would affect 0.35% and the number needed to treat would be 288.5. If all the venereal warts were in uncircumcised men (13,522 cases) then only 0.21% would get infected, and the number needed to treat would be 484.6. Phimosis and paraphimosis hospitalizations (110,562) account for only 1.69%, with a number needed to treat of 59.3. In the broad scheme of things, these numbers are trivial, and on a cost/benefit calculation alone would certainly not justify general routine circumcision in advance. [6] It is significant that the volume discussed here was published in 1987, and written by American medical doctors who had clearly been acculturated into America’s post-war love affair with circumcision. There is no detailed study of the history of circumcision in the United States, but several studies have suggested that the practice was already popular in the 1930s, became even more deeply embedded in the 1950s-60s, and that the influence of the U.S. Military was a significant factor in this development. [7] The passages quoted above are riddled with speculative assertions about what would or would not have happened if the men experiencing penis problems had been circumcised in advance. But since there are no comparative figures on the incidence of warts, balanitis or venereal infections in circumcised as compared with uncircumcised men, how can we be sure that the latter were disproportionately affected? The British army surgeon Sir Daniel Whiddon asserted that in the Middle East campaigns it was the circumcised men who were more affected by venereal disease: “The shaky science of the arguments in favour of wholesale infant circumcision is often supported by the statement, itself unsupported by any by any scientific evidence, that the circumcised are less liable to disease, particularly that they are less likely to get venereal disease and cancer. The first statement is untrue. You were long enough in the Middle East to know that our circumcised allies were the most enthusiastic supporters of the VD departments.” [8] Of course you cannot experience phimosis if you lack a foreskin with which to experience it, but then, without testicles or a prostate you won’t be at risk of testicular or prostate cancer. The definitions of phimosis given in these passages are very loose, and seem to based on the outdated Edwardian idea that a non-retractile foreskin was in itself pathological, rather than on the scientific understanding that developed in the wake of Douglas Gairdner’s research. [9] As soon as penicillin became available, most venereal diseases were routed away from urology; in those primitive days doctors circumcised for many conditions that would now be treated topically with antibiotics or other medications. The medical history volumes of the Australian official history do not mention problems caused by “lack of circumcision” in the jungles of New Guinea, and if more recent evidence is sought, there is significantly no mention of foreskin problems or circumcision in relation to control of venereal disease, balanitis or any other health issue in Ian Howie-Willis’s biography of Major-General Sir Samuel Burston, the officer in charge of Australian army medical services throughout the Pacific campaign. [10] In response to an inquiry from me, Dr Willis replied: “If circumcision had been practised as widely as your ‘urban myth’ would have it, I’d also expect that it would have been the subject of one of the many ‘technical bulletins’ issued to Medical Corps staff by the successive Directors General of Medical Services. I’ve seen most of these bulletins but certainly didn’t see one dealing with circumcision either in the context of VD or balanitis. Similarly, this is a topic which is never mentioned in any of Burston’s official or personal correspondence, which I’ve read thoroughly. … The reason that circumcision doesn’t appear in my book is that I never encountered its occurrence during my research.” (Email, 1 August 2012) Among the Australian military, it would seem that the foreskin was not seen as some sort of rogue organ and circumcision not hailed as the solution. Accordingly, one suspects that the problems identified so readily by American medical personnel had more to do with their pre-existing animus against the foreskin than with an objective appraisal of the issues. What so many of the comments (Montgomery’s especially) embody is the post-war consensus that baby boys should be circumcised as a matter of course. Worth noting is the admission that military headquarters questioned the need for so many circumcisions, suggesting that the field medical corps had a basic anti-foreskin attitude, and operated whenever there was the slightest excuse. So much for Morris’s use of Dr (not General) Patton. His other references are equally dodgy. The claim about Desert Storm relies on unsourced allegations by Edgar Schoen, an even more vigorous anti-foreskin activist than Morris himself, [11] and on the very article by Gardiner that I refute in my paper in the NZ Medical Journal. Morris is rightly critical of anecdotal evidence, but one of Gardiner’s key pieces of evidence for the “sand problem” was his claim that “a German surgeon” had told him that German Africa Corps troops had “suffered in the same way”, and had similarly been circumcised. But as I remark in my paper, the proposition that a German under the rule of Nazism would have submitted to an operation that could have identified him as a Jew, or that anybody in authority would have recommended such a course, is implausible. To make sure, Mr Hugh Young questioned Manfred Rommel, son of the German commander, who replied: “I have never heard that soldiers in the Africa Corps were circumcised. The veterans I could contact have not either.” Morris’s final claim, that “in the Vietnam War men requested circumcision to avoid ‘jungle rot,’” is backed up by no reference at all; but I am willing to concede that in humid, jungle conditions fungal and related conditions would have been a much greater problem than in the dry heat of the desert – tinea and worse between the toes and under the arms, for example. But we do not hear of doctors recommending amputation of the toes as a cure, or prophylactic digitectomy as prophylaxis. In short, for all Professor Morris’s huffing and puffing, there remains no evidence that ritual circumcision in the Middle East arose from hygienic/medical considerations, nor that troops engaged in the North African campaigns suffered epidemics of balanitis and other inflammations caused by sand and dust under their foreskin. As I concluded in my paper, such assertions are medical urban myths. NOTES and REFERENCES 1. Brian Morris, Circumcision facts trump anti-circ fiction. Australian Skeptic 27 (4) Summer 2007, 57. 2. Most recently, The child’s right to an open future: Is the principle applicable to non-therapeutic circumcision?<a href="http://jme.bmj.com/content/39/7.toc"> Journal of Medical Ethics 39</a> (July 2013). 3. Professor Basil Donovan has described him as “a man on a mission to rid the world of the male foreskin”: review of Morris, In Favour of Circumcision, in Venereology 12, 1999, 68-9. <a href="http://www.historyofcircumcision.net/index.php?option=content&task=view&id=64">Text available at History of Circumcision</a> 4. Robert Darby, <a href="http://journal.nzma.org.nz/journal/118-1218/1564/">The riddle of the sands: Circumcision, history and myth</a>. New Zealand Medical Journal 118, 15 July 2005. 5. The correct citation is Medical Department, United States Army. Surgery in World War II. UROLOGY. Edited by John F. Patton MD. (Washington: Office of the Surgeon General and Center of Military History, United States Army, 1987) Online at: http://babel.hathitrust.org/cgi/pt?id=mdp.39015026943020 6. Figures calculated by Dr Robert Van Howe, Department of Pediatrics, Central Michigan University. 7. Edward Wallerstein. Circumcision: An American Health Fallacy. New York: Springer, 1980; Frederick Hodges. “A short history of the institutionalization of involuntary sexual mutilation in the United States”, in George C. Denniston and Marilyn Milos (eds), Sexual Mutilations: A Human Tragedy, New York: Plenum Press, 1997; Robert Darby. <a href="https://www.amazon.com/dp/B00AXPRD1Q">The Sorcerer’s Apprentice: Why Can’t the United States Stop Circumcising Boys?</a> e-book, Amazon, 2013. 8. Whiddon D. <a href="http://www.cirp.org/library/general/widdicombe/">The Widdicombe file</a>. Lancet 1953;ii (15 Aug):337-8. 9. Gairdner D. The fate of the foreskin: A study of circumcision. Br Med J 1949;2:1433-7. For a listing of recent studies <a href="http://www.cirp.org/library/treatment/phimosis/">see collection at CIRP</a>. 10. Ian Howie-Willis. A Medical Emergency: Major-General ‘Ginger’ Burston and the Army Medical Service in World War II. Newport, NSW: Big Sky Publishing, 2012. 11. And one whose own use of evidence sometimes has its shortcomings: see Robert Darby and John Cozijn, <a href="http://sgo.sagepub.com/content/3/4/2158244013508960.full">The British Royal Family’s Circumcision Tradition: Genesis and Evolution of a Contemporary Legend</a>. Sage Open, 16 October 2013. <a href="http://www.circumstitions.com/sand.html">See also "He might have to fight in the desert"</a> at Circumstitions. NOTE: This reply was submitted to The Skeptic magazine, but was refused publication. </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Circumcision and sand revisited: a skeptical reply to Brian Morris darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> Recent public statements from Germaine Greer, one of Australia's most famous expatriates, and Paul Mason, Commissioner for Children Tasmania, show that there is growing support for children's rights and deepening concern that Australia is not doing enough to protect children from physical harm. <h2>Paul Mason: Children should be treated as fully human</h2> The following speech was given by Paul Mason, Commissioner for Children, Tasmania, at the joint FORWARD-NORM-UK press conference, in London, on 3 September 2008. <img alt="" class="image-right" height="421" src="https://www.circinfo.org/images/cliphiswings_000.jpg" width="300"/> Thank you everybody. The commissioner of children, like your commissioners of children in the United Kingdom, is a body independent of elected government and created under statute that deals with child protection. It does not import the rights of children from the United Nations Convention on the Rights of the Child (CRC) into domestic Tasmanian law. It says these are the guiding principles. So when I came into the job a year and a half ago, I was looking at a wide range of issues. I stumbled across FGM (Female Genital Mutilation), and I will be glad to talk to Naana [Otoo-Oyortey MBE, Executive Director of FORWARD] about this later. In Tasmania and Australia we do have government programs to educate, assist and support families who feel the pressure to conduct genital mutilation on the girls. We are devising various ways of assisting those families around the very problems Naana is talking about. We also have legislation like your legislation in the UK that criminalizes the procedure and criminalizes parents traveling out of the jurisdiction in order to have the procedure conducted on their daughters. I will start my speech by referring to the person in Tasmania who leads the bicultural teams in Tasmania. When I first talked to her about FGM a year ago she said, “You know what? 100% of the time, when we hear through the grapevine that a family is contemplating a procedure on a girl or is contemplating leaving for Indonesia to have the procedure done there, 100 per cent of the time they say to us, “You do it to boys! You DO NOT tell us not to do it to girls!” And she said meeting this response is like walking into a brick wall. We have not yet come up with an answer for that. So I said to this bicultural leader, “I think I can help you. I think I can help you, if we can work together, yourself as a professional and myself as an independent advisor to the government to try and turn around the eyes of government.” What needs to be changed? Marilyn [Milos] told me she’d been working within this organization and Steven [Svoboda], John [Geisheker], David [Llewellyn] and other people have been slugging away at this issue for decades before I stumbled upon it last year. I think there can be an element of navel gazing in the movement, with everybody sitting around congratulating each other for their views. And the reason I have come halfway around the world from a tiny rocky island town in Australia is because I really do want something to happen. I want our message to be heard in the larger world. My British grandfather always talked about the “golden thread” of British law, the presumption of innocence. The golden thread in the circumcision issue is the rights of the child. All of the arguments of the proponents for FGM and for male circumcision revolve around the needs of adults. They all revolve around religious needs of adults, cultural needs of adults, traditional needs of adults and the epidemiological studies by adults about adult sexually transmitted diseases. Adults are saying these are appropriate things to do to children. My perspective as Tasmania’s Commissioner for Children is that I am responsible for 117,000 children out of Tasmania’s total population of 480,000. My approach to my job has always been to lower the camera angle and look at the world from about table height. What do you see? The world looks enormously different from down there. Cars are a lot bigger and faster. Parks are a lot more beautiful, and your body is much more connected with yourself and who you are. That has been my perspective and my approach to this whole issue and I think that’s the easiest way to respond to the HIV trials in Africa. The most recent information from the World Health Organization (WHO) is that genital modification surgeries are being botched and need to be done properly in order to achieve a good outcome. That is all very well and I might enter the debate of what adults want to do with adults and what adult health promotion programs want to do with adults. But WHO should take great care regarding non-emergency surgery on children. I am concerned about children and I am concerned about the voice of the voiceless. Human rights for children are a new thing. Children in history have been treated as chattel for disposal. They have been treated as slaves. In later times, they have been treated as cheap labor. Only in the very end of last century did they start to be seen as people. In 1948, the United Nations Declaration of Human Rights, which includes a reference to personal integrity, does not refer directly to children. It does talk about people. It took until 1989, when the CRC was created, for the U.N. to clear up this particular dilemma and say maybe we ought to have rules for children as well because people seem to be overlooking that fact that children are people. The rights that were protected under the United Nations Declaration of Human Rights in 1948 were being ignored when it came to the little people. We got a new set of rules in 1989. The march of children toward full humanity continues. I see all the people involved in intactivism as being involved with the march of history towards protecting the humanity of children. This is what it is about. This is why I am optimistic. It may not be in my lifetime, but I know there are cultures that perform mutilation on the boys and girls in their own cultures that used to do other things in their own histories that they no longer do. All cultures change. That is good news for us. It is good news for all the people living in those cultures. I am interested to hear Naana report that women do not think that circumcision is a good idea for their sisters, aunties, mothers, and girls. That voice is a voice that emerged from this century and at the end of last century. That voice was not present 150 years ago. So history marches forward. Germaine Greer said she was not concerned about the setbacks for feminism. She said history marches two steps forward and one step back. That is a wonderfully direct view of history. I acknowledge Germaine for that. I have to acknowledge Australia for that; she is possibly the most famous Australian. (<a href="https://www.circinfo.org/ChildProtection.html#greer">See Germaine Greer's remarks on male and female genital mutilation below</a>.) It is often said that parents have a right to decide what surgery their children undergo. But the other change that emerged from the twentieth century is the understanding that the rights of person A cannot trump the rights of person B. The rights of children are discrete. They exist on their own. If you ask children, they will agree with you. If you ask parents, they tend to get a little funny about questions of whether or not they have the right to hit “their” child, to whip “their” child, to wound “their” child or to ask a doctor to wound “their” child on their behalf. I think one of the ways this movement is going to broaden its message is to tackle the medical profession, not primarily on medical grounds but on the human rights issues and the financial issues. I am here to bat for the children of Tasmania who are still at risk of genital mutilation and of injury by corporal punishment in the home. I have come all this way because I believe that no one who champions the rights of children can support the practice of routine neonatal circumcision. If a child grows up and wants to have a circumcision for any reason, I respect that. But the child who is a neonate can not make that decision. Article Two of the Convention on the Rights of the Child says the child has the right to have a voice in decisions that are made about the child. There is no urgency to circumcision. So my message about circumcision is that it can wait. I call on all congress-people and all commissioners of children in every jurisdiction around the world to work together to eradicate this practice and to eradicate all non-medically indicated surgical practices on children of all kinds. Source: <a href="http://www.arclaw.org/">ARC Newsletter</a>, Vol. 7 (3), Fall 2009. <a href="http://www.forwarduk.org.uk/">Forward</a> is the UK organisation concerned with female genital mutilation and<a href="http://www.norm-uk.org/"> Norm-UK</a> the organisation focused on male circumcision. <h2> <a id="greer" name="greer"></a>Germaine Greer on male and female genital mutilation</h2> Germaine Greer was in the news recently, speaking at the Festival of Dangerous Ideas in Sydney, where she attacked treatment of children and criticised Australia’s failure to protect them from many forms of physical harm, including circumcision. She made the point that in most states dogs enjoy better legal protection from cruel treatment than boys. Speaking under the banner that freedom is the most dangerous idea of all, Dr Greer said children are the least free of all, and are owned like pets or slaves. “They can be mutilated with impunity,” she said. “No baby asks to be circumcised, or baptised for that matter. … We don’t recognise protest in children … against the conditions in which they are being raised, against a culture that is deeply hostile to children and frightened of them. Now in case that sounds like one of my madder and more exaggerated sayings, just think about it.” (<a href="http://www.smh.com.au/articles/2009/10/04/1254590909543.html">Sydney Morning Herald, 5 October 2009</a>) Greer made further critical comments on the common double standard whereby female genital mutilation (circumcision of girls or women) is regarded as a hideous abomination while circumcision of male infants or boys (male genital mutilation) is tolerated, approved or regarded as a suitable subject for coarse humour. In her book The Whole Woman she writes: “Any suggestion that male genital mutilation should be outlawed would be understood as a frontal attack on the cultural identity of Jews and Muslims. Notwithstanding, the opinion that male circumcision might be bad for babies, bad for sex and bad for men is steadily gaining ground. In Denmark only 2 per cent of non-Jewish and non-Muslim men are circumcised on strictly medical grounds; in Britain the proportion rises to between 6 and 7 per cent, but in the US between 60 and 70 per cent of male babies will have their foreskins surgically removed. No UN agency has uttered a protocol condemning the widespread practice of male genital mutilation, which will not be challenged until doctors start to be sued in large numbers by men they mutilated as infants. Silence on the question of male circumcision is evidence of the political power both of the communities where a circumcised penis is considered an essential identifying mark and of the practitioners who continue to do it for no good reason. Silence about male genital mutilation in our own country combines nicely with noisiness on female mutilation in other countries to reinforce our notions of cultural superiority”. She also comments: “Male genital mutilation is considered trivial; female genital mutilation is considered devastating even if it involves nothing more than nicking the prepuce of the clitoris to provoke ritual bleeding.” She also claims: “The American Academy of Pediatrics recommends that clitorises of more than three-eighths of an inch should be removed from baby girls before they are fifteen months old. Five such procedures are performed every day in the United States; such “reconstructive surgery” is not included in world statistics which estimate that 120 million women alive today have suffered genital mutilation.” The source for this claim appears to be Martha Coventry, “The tyranny of the esthetic: Surgery’s most intimate violation”, in On the Issues: The Progressive Woman’s Quarterly, Summer 1998, p. 16 <h3>Comment</h3> In these passages Dr Greer is most interested in attacking double standards. Her point is that if Jews and Moslems are allowed to do it to boys, why shouldn’t Ethiopians and Somalis be allowed to do it to girls? She is actually inclined to defend female circumcision in tribal cultures, though it is not entirely clear whether this defence extends to forcible mutilation of girls, or whether it is limited to situations where mature women voluntarily seek it. If the latter, she reaches a position similar to that of <a href="http://www.cirp.org/library/legal/mason1/">Christine Mason in Exorcising excision</a>: that forcible circumcision of minors of either sex should not be permitted, but that elective circumcision of either sex after the age of consent should not be restricted. We would regard Martha Coventry’s claim with scepticism, though it is undoubtedly true that there are cases (in both the U.S.A. and Australia) where doctors have cut the clitorises of girls at the request of parents. For details of one woman’s experience, see Patricia Robinett, The Rape of Innocence: One Woman’s Story of Female Genital Mutilation in the U.S.A. (Eugene, OR: Aesculapius Press, 2006.) It is also true that many doctors (and not only in the U.S.A.) regard “excessive” foreskin length as yet another reason for circumcision. Source: Germaine Greer, The Whole Woman (London: Doubleday, 1999), pp. 94-96 </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Paul Mason and Germaine Greer on the rights of children darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> Safety and Efficacy of Nontherapeutic Male Circumcision: A Systematic Review Caryn L. Perera, BA, Grad Cert EBP, Franklin H. G. Bridgewater, MBBS, FRACS, Prema Thavaneswaran, BSc (Hons), PhD and Guy J. Maddern, PhD, FRACS Annals of Family Medicine Volume 8, Issue 1, January/February 2010 ABSTRACT PURPOSE: We wanted to assess the safety and efficacy of nontherapeutic male circumcision through a systematic review of the literature. METHODS: We systematically searched The York Centre for Reviews and Disseminations, Cochrane Library, PubMed, and EMBASE databases for randomized controlled trials published between January 1997 and August 2008. Studies reporting on circumcision in an operative setting in males of any age with no contraindications to or medical indications for circumcision were eligible for inclusion. The main comparator was intact genitalia. From 73 retrieved studies, 8 randomized controlled trials were ultimately included for analysis. RESULTS: Severe complications were uncommon. Analgesia/anesthesia during circumcision was promoted. The prevalence of self-reported genital ulcers was significantly lower in circumcised men than uncircumcised men (3.1% vs 5.8%; prevalence risk ratio 0.53; 95% confidence interval [CI], 0.43–0.64; P<.001). Circumcised sub-Saharan African men were at significantly lower risk of acquiring human immunodeficiency virus/acquired immune deficiency syndrome than were uncircumcised men (random effects odds ratio = 0.44, 95% CI, 0.32–0.59; P <.001). The evidence suggests that adult circumcision does not affect sexual satisfaction and function. CONCLUSIONS: Strong evidence suggests circumcision can prevent human immunodeficiency virus/acquired immune deficiency syndrome acquisition in sub-Saharan African men. These findings remain uncertain in men residing in other countries. The role of adult non-therapeutic male circumcision in preventing sexually transmitted infections, urinary tract infections, and penile cancer remains unclear. Current evidence fails to recommend widespread neonatal circumcision for these purposes. Research Recommendation Although approximately 30% of the global male population is circumcised, there is a paucity of high-quality evidence. Depending on the indication under investigation, prospective RCTs and case-control studies should be conducted to strengthen the evidence base and allow more informed conclusions on nontherapeutic male circumcision to be drawn. Although the evidence for the efficacy of adult nontherapeutic male circumcision in preventing HIV/AIDS acquisition in sub-Saharan African men is strong, it is unclear whether these findings can be extrapolated to male populations in other countries. The role of adult nontherapeutic male circumcision in preventing sexually transmitted infection, urinary tract infection, and penile cancer is less clear, whereas the role of neonatal circumcision in preventing HIV/AIDS, sexually transmitted infection, urinary tract infection, and penile cancer is not presently supported by RCT evidence. Patients who request circumcision in the belief that it bestows clinical benefits must be made aware of the lack of consensus and robust evidence, as well as the potential medical and psychosocial harms of the procedure. As the efficacy of prophylactic nontherapeutic male circumcision has not been comprehensively studied in neonates, it would be inappropriate to recommend widespread neonatal circumcision for this purpose. <a href="http://www.annfammed.org/" rel="noopener" target="_blank">Full text of the article may be read at Annals of Family Medicine</a> <h3>Comment</h3> This level-headed article comes as a welcome breath of fresh air, and confirms the policy of the Royal Australasian College of Physicians to discourage medically unnecessary circumcision of minors. The bottom line is that (routine) preventive circumcision of minors offers no significant health benefit, carries significant risks, has an adverse effect on sexual sensation, and should not be performed. There are two points that might be questioned. First, the estimate of 30 per cent of men world-wide circumcised seems too high. Even allowing that most Muslims are circumcised (and there are probably many who are not), and that circumcision is common among tribal societies in Africa, it does not seem likely that the total could be much more than 25 per cent – though of course, fuelled by American dollars and those Microsoft millions, the World Health Organisation is certainly doing its best to make Africa foreskin-free. In fact, circumcision is rapidly becoming a practice confined to the underdeveloped world, where people who do not know any better have no choice but to obey those white witchdoctors. Second, to conclude that “the evidence suggests that adult circumcision does not affect sexual satisfaction and function” suggests that the search for evidence has not been as thorough as it might have been. It is highly likely that circumcision in adulthood has a far less severe effect on sexual function and genital sensation than if it is done in infancy or childhood (for which reason maturity is a much better time to do it, if it must be done), but there are plenty of men, circumcised as adults, who report a significant loss of sexual feeling, and who bitterly regret their decision. </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Australian study finds insignificant benefits of circumcision darby