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Who's looking after the boys?

19 May, 2010

Who's looking after the boys?

Female genital mutilation is a frequently discussed topic by midwives and policy-makers alike, but Ann Higson highlights the often-ignored subject of enforced male circumcision on children.

Female genital mutilation is a frequently discussed topic by midwives and policy-makers alike, but Ann Higson highlights the often-ignored subject of enforced male circumcision on children.

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Midwives magazine: June/July 2010
For some time now the issue of female genital mutilation (FGM) or female circumcision has been a hot topic of conversation within midwifery circles. It is an unnecessary abuse inflicted onto children in order to control their sexuality and promote chastity. FGM is illegal in the UK.

Male genital mutilation (MGM) or male circumcision has been largely ignored. It is an unnecessary abuse inflicted onto children in order that they may conform to religious or cultural beliefs. MGM is legal in the UK.

The universal declaration of human rights state that every man, woman and child should have equal rights without discrimination (United Nations, 1948). These rights should have meaning within our everyday lives and aim to protect all people from injustice.

FGM is considered a violation of human rights by the World Health Organization (WHO, 2001). Their only concern regarding MGM is that local communities should make it freely available for neonates and children as research has shown that in countries where AIDS is rife, it can reduce transmission by up to 60% (Auvert, 2005).

Tobian et al (2009) found a significant reduction of human papillomavirus (HPV) in their circumcised group. HPV transmission during sexual intercourse can cause cervical cancer (Muñoz et al, 2003). These are impressive results and they will certainly give credence and support to parents who wish their children to be circumcised. However, children are not sexually active until they become aware of their sexuality. Perhaps delaying male circumcision until the child can make an informed choice would reduce violations of his human rights?

The British Medical Association (BMA, 2006) sit on the fence with this issue and can only recommend that MGM be carried out by a competent person and that consent is gained by both parents. They believe that it is up to society to put restraints on parental choices. However, they do conclude that parents do not have the right to demand that medical professionals carry out unnecessary surgical procedures on their children.

According to Glass (1999), Jewish law requires that male neonates undergo circumcision on the eighth day following their birth. This is generally carried out without any form of analgesia, although one Jewish mother told me that her son would be given a ‘taste of wine’ before the ceremony.

The Koran does not require MGM, though it is generally accepted that Islamic males should be circumcised. This is seen as a rite of passage into the Islamic faith and is usually carried out before puberty (Adamec, 2007). Analgesia is used with children, but not neonates. FGM is seen by the Islamic faith in general as a ‘barbarous cultural practice that pre-dates Islam’ (Maqsood, 2008).

It has now been accepted that neonates are capable of feeling pain (Anand et al, 1987). Performing MGM on a neonate without analgesia can therefore be assumed to be a painful experience (Wellington and Rieder, 1993). Research has also shown that circumcised males show a higher behavioural pain score several months after MGM while undergoing vaccinations (Taddio et al, 1995). This suggests that male neonates are not only suffering physically but psychologically from this early painful stimuli.

Morbidity rates are estimated to range from 0.1% to 35%, according to the American Academy of Family Physicians (AAFP) (2007). The most common complications are infection, haemorrhage and failure to remove enough foreskin (Kaplan, 1983). Rare complications include:

✲ Necrotising fascitis – inflammation due to bacterial infection
✲ Meatitis – inflammation of the urethral opening
✲ Meatal stenosis – abnormal narrowing of the urethral opening
✲ Urethral fistula – abnormal opening within the penile tissue
✲ Penile necrosis – death of some or all of the cells of the penis
✲ Penile amputation – surgical removal of all or part of the penis (AAFP), 2007).

The mortality risk of MGM is 1:500,000 (AAFP, 2007).

Some countries have passed laws to stop non-medical individuals from performing MGM on infants, and in Australia, a few states have stopped the practice of non-therapeutic male circumcision in public hospitals. Put together, these two sanctions would both be needed to protect neonates within the UK.

Unless the act of performing MGM becomes a child abuse issue in the UK and therefore illegal, male children will continue to be denied their human rights. It seems unfair that girls are protected against FGM by law, while boys are left to suffer. Perhaps using the word ‘mutilation’ to describe female circumcision helped society to recognise the harm done to young girls by this practice? By penning the term ‘male genital mutilation’, a similar response could be hoped for, in order to find a solution to what is at present a very sensitive issue. 


American Academy of Family Physicians. (2007) Circumcision: position paper on neonatal circumcision. See: www.aafp.org/online/en/home/clinical/clinicalrecs/circumcision.html (accessed 16 April 2010).

Adamec CW. (2007) Islam: a historical companion. Tempus Publishing: Gloucestershire.

Anand KJS, et al. (1987) Pain and its effects in the human neonate and fetus. New England Journal of Medicine 317(21): 1321-9.

Auvert B, et al. (2005) RCT of male circumcision for reduction of HIV infection risk. PloS Medicine 2(11): 1112-22.

British Medical Association. (2006) The law and ethics of male circumcision: guidance for doctors. See: www.bma.org.uk/images/Circumcision_tcm41-147277.pdf (accessed 16 April 2010).

Glass JM. (1999) Religious circumcision: a Jewish view. BJU International 83(1): 17-21.

Kaplan GW. (1983) Complications of circumcision. Urol Clin North Am 10: 543-9.

Maqsood RW. (2008) Need to know? Islam. Harper Collins: London.

Muñoz N, et al. (2003) Epidemiologic classification of human papillomavirus types associated with cervical cancer. New England Journal of Medicine 348: 518-27.

Taddio A, et al. (1995) Effect of neonatal circumcision on pain responses during vaccination in boys. The Lancet 345(8945): 291-2.

Tobian A, et al. (2009) Male circumcision for the prevention of HSV-2 and HPV infections and syphilis. New England Journal of Medicine 360(13): 1298-309.

United Nations. (1948) The universal declaration of human rights. See: www.un.org/en/documents/udhr (accessed 16 April 2010).
Wellington N, Rieder MJ. (1993) Attitudes and practices regarding analgesia for newborn circumcision. Pediatrics 92(4): 541-3.

WHO. (2001) FGM: integrating the prevention and the management of the health complications into the curricula of nursing and midwifery. WHO: Geneva.

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