Doctors and Children's Groups Say Male Circumcision Must be Voluntary, Consensual

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National Institutes of Health's endorsement of adult male circumcision leaves the question of infant circumcision unanswered.

Physicians and children's rights advocates are calling on the U.S. National Institutes of Health (NIH) to formulate a clear policy on male circumcision so that minors are protected from being circumcised for medically unnecessary reasons. The plea follows Wednesday's NIH announcement that findings from two new African clinical trials show that adult male circumcision helped protect men from acquiring the HIV/AIDS virus over a 15 month period.

The first trial in Kisumu, Kenya, of 2,784 HIV-negative men showed a 53 percent reduction of HIV acquisition in circumcised men relative to uncircumcised men, while the second trial of 4,996 HIV-negative men in Rakai, Uganda, showed that HIV acquisition was reduced by 48 percent in circumcised men. The trials were originally scheduled to continue until mid-2007, but the NIAID Data and Safety Monitoring Board halted them early after deeming the interim data sufficient enough to draw conclusions.

"The only complete protection against HIV is safe sex and any decision to circumcise should be made by the owner of the foreskin when he is able to give informed consent," says David Smith, who is General Manager of NORM-UK, a UK based foreskin health charity. "The British Medical Association (BMA) has recently revised their 2003 guidance on the law and ethics of male circumcision. The revised guidance dated June 2006 reaffirms the statement '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'".

In the UK, non-therapeutic male circumcision is not available on the National Health Service, and a Korean study by DaiSik Kim and Myung-Geol Pang, published in the online edition of British Journal of Urology earlier this month, found that "circumcision adversely affects sexual function in many men, possibly because of complications of the surgery and a loss of nerve endings". The study confirms widespread reports from men who claim that circumcision has damaged their sex lives.

Paul M. Fleiss, MD, MPH, a Los Angeles pediatrician and author of the book "What Your Doctor May Not Tell You About Circumcision", said that the male foreskin has sensory and protective functions that are lost after circumcision. "The foreskin contains a rich concentration of blood vessels and nerve endings that are designed to enhance sexual pleasure," said Fleiss. "And just as the eyelids protect the eyes, the foreskin protects the glans and keeps its surface soft, moist, and sensitive. These functions make it ethically imperative that circumcision only be performed on adults who have given their consent."

Dr. Dean Edell, syndicated radio host of "The Dr. Dean Edell Show" and anchor of "Medical Minutes", a series of ten weekly radio medical reports, said that using routine male circumcision to prevent AIDS is flawed logic. "AIDS is caused by a virus, not by the foreskin," said Edell. "The foreskin is one of several possible entrance points for the AIDS virus to infect the body, but that does not mean that you should cut the entrance off. It means that you should protect the entrance, either by using condoms or by practicing safe sex. If some men want to undergo circumcision because they feel it will make them safer, then they should be free to do so. But we need to draw the line when it comes to circumcision of children, which is done without consent of the patient. The common sense thing to do here is to make circumcision an option for adults only."

Although female circumcision of minors was outlawed by Congress in 1996, a similar law does not exist to protect males. As a result, circumcision is still performed on nearly 60% of infant boys, either because the parents request it or because a doctor or religious advisor recommends it.

Matthew Hess, President of San Diego based, said that a consent law for male circumcision should be enacted by Congress to give men the same choices that women have when it comes to elective surgery. "The new NIH suggestion that adult male circumcision may be used as a tool to protect against AIDS is going to tempt many physicians to circumcise children as well. But removal of healthy, non-diseased tissue is elective surgery that should be the choice of the person who owns the body, not the choice of parents or physicians." has authored proposed federal and state legislation that would require men to be 18 years old before undergoing circumcision. The legislation is endorsed by 16 health and human rights groups, but has yet to be enacted into law.


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