L Is Lhe worId's mosL commonIy perIormed surgIcuI procedure - buL more Lhun uny

oLher IL now dIvIdes gIobuI medIcuI opInIon.

MuIe cIrcumcIsIon - Lhe removuI oI Lhe IoreskIn, normuIIy perIormed soon uILer bIrLh
or uL puberLy - hus become Lhe subjecL oI u bILLer dIspuLe beLween medIcuI
uuLhorILIes on eILher sIde oI Lhe ALIunLIc.
AL Issue Is u smuII sheuLh oI doubIe IoIded skIn und muscIe, rIch In bIood vesseIs und
nerve endIngs, whose IuncLIon remuIns uncIeur. CIuIms huve been mude LhuL ILs
removuI Ieuves Lhe heud, or "gIuns", oI Lhe penIs exposed, reducIng sensuLIon und
sexuuI pIeusure, buL no consensus on LhIs, or on much eIse, exIsLs. The WorId HeuILh
OrgunIsuLIon suys oI Lhe IoreskIn, Lhere Is "debuLe ubouL ILs roIe".
SupporLers oI cIrcumcIsIon suy ILs removuI brIngs sIgnIIIcunL medIcuI udvunLuges
LhuL ouLweIgh uny rIsks. LusL monLh uIone Lwo sLudIes uppeured exLoIIIng ILs heuILh
beneIILs, wILh one specIuIIsL cIuImIng LhuL IL provIdes proLecLIon (uguInsL urInury
LrucL InIecLIons und sexuuIIy LrunsmILLed dIseuses) on u pur wILh chIIdhood
vuccInuLIon und LhuL Lo IuII Lo oIIer IL Lo Lhe purenLs oI newborn boys shouId be
regurded us uneLhIcuI.
YeL IusL OcLober, Lhe CouncII oI Europe pussed u resoIuLIon condemnIng Lhe prucLIce
us u "vIoIuLIon oI Lhe physIcuI InLegrILy oI chIIdren" und cuIIIng Ior u pubIIc debuLe
wILh Lhe uIm oI bunnIng Lhe prucLIce "beIore u chIId Is oId enough Lo be consuILed".
Norwuy, Sweden, Denmurk, FInIund, und ceIund joIned Iorces Lo cuII Ior u bun,
IoIIowIng Lhe Ieud u yeur eurIIer Irom u Germun regIonuI courL In CoIogne, whIch
ruIed LhuL Lhe prucLIce umounLed Lo bodIIy hurm und bunned IL Ior InIunLs und young
boys beIow Lhe uge oI consenL.
ThuL provoked un ungry reucLIon Irom JewIsh und MusIIm Ieuders, umong whose
communILIes rILuuI cIrcumcIsIon hus been perIormed Ior cenLurIes, whIch wus
reIgnILed by Lhe CouncII oI Europe resoIuLIon. They bIumed Lhe uLLucks on IeIL-wIng
secuIurIsLs und rIghL wIngers IeurIuI oI Lhe InIIuence oI ImmIgruLIon Irom MusIIm
counLrIes.
n Murch, Ieuders oI Lhe CouncII oI Europe LrIed Lo cuIm Lhe debuLe wILh u IeLLer
udvIsIng purIIumenLurIuns uguInsL IurLher uLLempLs Lo LurgeL rILuuI cIrcumcIsIon on
Lhe grounds LhuL "Lhe proLecLIon oI chIIdren Is provIded by exIsLIng InLernuLIonuI
InsLrumenLs".
The Issue Is so sensILIve LhuL IookIng uL Lhe evIdence, weIghIng IL up und decIdIng
whuL Is besL Ior chIIdren, us docLors ure supposed Lo do, Is vIrLuuIIy ImpossIbIe.
RecognIzIng LhIs, mosL medIcuI orgunIsuLIons huve Ior decudes sLuyed uIooI Irom Lhe
Issue, noLIng mereIy LhuL surgery Is rureIy medIcuIIy necessury, excepL In Lhe LIny
mInorILy oI cuses where Lhe IoreskIn wIII noL reLrucL. They huve preIerred Lo Ieuve IL
Lo purenLs und Lhe pubIIc Lo decIde wheLher Lhe procedure Is eLhIcuI when currIed ouL
Ior reIIgIous or oLher non-medIcuI reusons. However, In zoo8, un edILorIuI In The
New EngIund JournuI oI MedIcIne, Lhe worId's premIer medIcuI journuI, puL un end
Lo LhuL cosy consensus by noLIng Lhe uccumuIuLIng evIdence LhuL removuI oI Lhe
IoreskIn couId proLecL uguInsL u number oI sexuuIIy LrunsmILLed dIseuses.
CIrcumcIsIon reduces by per cenL Lhe rIsk oI InIecLIon wILh humun pupIIIomu
vIrus, u cuuse oI genILuI wurLs In boLh sexes und Lhe prIncIpuI cuuse oI cervIcuI cuncer
In women. L uIso provIdes proLecLIon uguInsL Lhe herpes vIrus, reducIng Lhe InIecLIon
rIsk by z per cenL. L Is LhoughL IIkeIy Lo proLecL uguInsL syphIIIs, Loo, buL Lhe sumpIe
sIze In Lhe NEJM reporL wus Loo smuII Lo be sIgnIIIcunL.
By Iur Lhe mosL drumuLIc eIIecL, however, Is ILs proLecLIve eIIecL uguInsL InIecLIon
wILh HV, wILh u o-6o per cenL reducLIon In rIsk umong cIrcumcIsed men. AduIL
muIe cIrcumcIsIon Is now wIdeIy seen us umong Lhe worId's besL deIences uguInsL Lhe
spreud oI AIds, und Is beIng used ucross sub-Suhurun AIrIcu In huge cumpuIgns
bucked by mIIIIons oI doIIurs.
AILhough HV Is u smuIIer probIem In wesLern counLrIes (und Lhere Is no evIdence
LhuL cIrcumcIsIon Is proLecLIve Ior guy men), humun pupIIIomu vIrus und herpes
vIrus cuuse u heuvy burden oI dIseuse und, In Lhe cuse oI cervIcuI cuncer, Lhousunds
oI deuLhs (und mIIIIons In Lhe deveIopIng worId).
The NEJM concIuded LhuL Lhe new evIdence wus sLrong enough Lo serve us u "cuII Lo
ucLIon" Ior proIessIonuI socIeLIes Lo re-exumIne LheIr poIIcIes on cIrcumcIsIon. The
AmerIcun Acudemy oI PuedIuLrIcs wus Lhe IIrsL Lo respond by esLubIIshIng u LuskIorce
und In zo1z IL pubIIshed un upduLed posILIon sLuLemenL.
HuvIng prevIousIy udvIsed uguInsL Lhe rouLIne cIrcumcIsIon oI boys, Lhe Acudemy
now suId purenLs shouId be educuLed ubouL Lhe beneIILs und rIsks und IL shouId be up
Lo Lhem Lo decIde. L urged Insurunce compunIes Lo puy Ior Lhe procedure, uddIng:
"The beneIILs oI newborn muIe cIrcumcIsIon jusLIIy uccess Lo LhIs procedure Ior Lhose
IumIIIes who choose IL."