Dutch doctors urge end to male circumcision
Dutch doctors want politicians and human rights groups to speak out and discourage the practice of male circumcision in the Netherlands because they say it is a “painful and harmful ritual,” and a violation of children’s rights.
Between 10,000 and 15,000 boys are circumcised in the Netherlands each year, mostly for religious reasons and not always with an anesthetic, according to the Royal Dutch Medical Association (KNMG) which represents surgeons, pediatricians, general practitioners and urologists.
“We want to discourage male circumcision, because it is an unnecessary procedure with complications, which violates the integrity of the child,” Lode Wigersma, a spokesman for the association, told Reuters on Friday.
“This is not an innocent procedure, we see complications in about 5 percent of the cases, as well as some long-term and psychological implications,” he said.
Male circumcision involves the removal of all or part of the foreskin of the penis. It is a ritual obligation for infant Jewish boys, and is also a common rite among Muslims, who account for the largest share of circumcised men worldwide.
The Dutch medical association has urged religious leaders to find alternative rites of passage that are not irreversible and which are not painful for the child.
The practice of female genital mutation has been prohibited by law in the Netherlands since 1993 for all ages.
Last year the Dutch medical association released a report against the practice of circumcision of male children for non-medical reasons, hoping to initiate a public discussion.
Now it is appealing to Dutch politicians to speak out against the practice to help “gradually change the mentality” in society and among religious groups that circumcise their boys.
The doctors group said that contrary to popular belief, circumcision can cause some minor as well as serious complications including bleeding, infection, urethral stricture as well as panic attacks, which it says are particularly common.
It said there was no medical reason to surgically remove a part of the genitals of healthy babies and young children, who are too young to give their consent to the procedure.
The Dutch doctors are not calling for a circumcision ban, for fear the practice will be driven underground.
“We also understand that it (circumcision) is a deeply embedded religious habit so we don’t expect it to be over in a few years, so our appeal is if you want to do it then have it done by a doctor with anesthesia,” said Wigersma.
The majority of male circumcisions in the Netherlands are done in special circumcision clinics by doctors using anesthetic on Muslim boys between 5 and 7 years, according to Wigersma.
Rabbi Binyomin Jacobs, President of the Dutch Association of Rabbis, said only about 50 male Jewish babies are circumcised in the Netherlands each year.
He disputed the 5 percent complication rate, and said there have not been any problems in the Jewish community due to strict rules about how and when circumcision takes place.
Are there benefits from circumcision?
There are several:
1. Many older men, who have bladder or prostate gland problems, also develop difficulties with their foreskins due to their surgeon’s handling, cleaning, and using instruments. Some of these patients will need circumcising. Afterwards it is often astonishing to find some who have never ever seen their glans (knob) exposed before!
2. Some older men develop cancer of the penis - about 1 in 1000 - fairly rare, but tragic if you or your son are in that small statistic. Infant circumcision gives almost 100% protection, and young adult circumcision also gives a large degree of protection.
3. Cancer of the cervix in women is due to the Human Papilloma Virus. It thrives under and on the foreskin from where it can be transmitted during intercourse. An article in the British Medical Journal in April 2002 suggested that at least 20% of cancer of the cervix would be avoided if all men were circumcised. Surely that alone makes it worth doing?
4. Protection against HIV and AIDS. Another British Medical Journal article in May 2000 suggested that circumcised men are 8 times less likely to contract the HIV virus. (It is very important here to say that the risk is still far too high and that condoms and safe sex must be used - this applies also to preventing cancer of the cervix in women who have several partners.)
A BBC television programme in November 2000 showed two Ugandan tribes across the valley from one another. One practised circumcision and had very little AIDS, whereas, it was common in the other tribe, who then also started circumcising. This programme showed how the infection thrived in the lining of the foreskin, making it much easier to pass on.
5. As with HIV, so some protection exists against other sexually transmitted infections. Accordingly, if a condom splits or comes off, there is some protection for the couple. However, the only safe sex is to stick to one partner or abstain.
6. Lots of men, and their partners, prefer the appearance of their penis after circumcision, It is odour-free, it feels cleaner, and they enjoy better sex. Awareness of a good body image is a very important factor in building self confidence.
7. Balanitis is an unpleasant, often recurring, inflammation of the glans. It is quite common and can be prevented by circumcision.
8. Urinary tract infections sometimes occur in babies and can be quite serious. Circumcision in infancy makes it 10 times less likely.
“According to Jewish law, you have to do it (circumcision) the Jewish way,” Jacobs said.
The doctors’ recommendation to end the practice of circumcision is likely to be controversial given that it involves both Jewish and Muslim traditions.
In a rare show of unity in June, the Dutch Muslim and Jewish communities - numbering about 1 million and 40,000 respectively in a total population of 16 million - condemned the government’s proposed ban on the religious slaughter of animals as a violation of their religious freedom.
Male circumcision for HIV prevention
There is compelling evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%. Three randomized controlled trials have shown that male circumcision provided by well trained health professionals in properly equipped settings is safe. WHO/UNAIDS recommendations emphasize that male circumcision should be considered an efficacious intervention for HIV prevention in countries and regions with heterosexual epidemics, high HIV and low male circumcision prevalence.
Male circumcision provides only partial protection, and therefore should be only one element of a comprehensive HIV prevention package which includes:
- the provision of HIV testing and counseling services;
- treatment for sexually transmitted infections;
- the promotion of safer sex practices;
- the provision of male and female condoms and promotion of their correct and consistent use.
###
-World Health Organization-HIV/AIDS-
###
By Roberta Cowan
AMSTERDAM