British journal: Circumcision is safe

WHO, UN program recommend procedure for all.

By
February 16, 2010 07:33
3 minute read.
An Israeli teaches a doctor in Swaziland to prefor

circumcision swaziland 311. (photo credit: Jerusalem AIDS Project)

 
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Jews, and later Muslims, knew what they were doing when requiring all boys to undergo circumcision, as a meta-analysis of research carried out in 21 countries and just published in the online journal BioMed Central Urology confirms.

One out of every three males in the world has been circumcised, and the procedure is almost always safe, especially when performed on infants and in sterile conditions.

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As the surgical procedure - minor for male infants - has been shown to reduce the risk of HIV infection by 60 percent, the World Health Organization and the Joint United Nations Program on HIV/AIDS have recommended neonatal and adult circumcision.

The British journal also found that complications are even more rare when the circumcision is performed by non-medical experts in the ritual under suitable conditions, due to their usually greater experience than surgeons.

The paper was authored by Dr. Helen Weiss and Natasha Larke of the London School of Hygiene and Tropical Medicine, Dr. Daniel Halperin of the Harvard School of Public Health, and Dr. Inon Schenker of the Jerusalem AIDS Project.

There have long been protests over the years in Britain and other countries against ritual circumcision of male infants, on the grounds that "they have not been asked for consent" and that there was "no medical justification" for the ritual practice. But the accumulation of studies showing that it indeed protects health (and even reduces papillomavirus infection in women who have sexual relations with circumcised males) have made the latter argument irrelevant.

The systematic review of 52 relevant papers written in a variety of languages and countries, including in Israel and Arab states, found that circumcision of newborn and older male babies by trained staff rarely results in complications. There are more risks among older males, especially when the circumcisors were not well trained or experienced, or performed the surgery under unsanitary conditions or with inadequate equipment.

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The team found that among boys before their first birthday, the frequency of relatively minor adverse events such as hemorrhaging, inflammation and infection was low (median 1.5% for any adverse event), while severe complications were very rare. If the boy was older than one year, circumcisions by medical providers tended to be associated with more complications (median 6%), although there were still few serious complications. However, more complications - and more severe ones - were observed when the foreskin was removed as a rite of passage into adolescence by inexperienced circumcisors or with inadequate equipment and supplies.

Although Jewish circumcision, usually on the eighth day after birth, was not singled out in the study, it is performed without general or other anesthesia according to Jewish law. Three Israeli studies were included in the meta-analysis.

The authors concluded that "male circumcision is commonly practiced and will continue to occur for religious, cultural and medical reasons. There is a clear need to improve safety of male circumcision at all ages through improved training or re-training for both traditional and medically trained providers, and to ensure that providers have adequate supplies of necessary equipment and instruments for safe circumcision."

Operation Abraham, a consortium of eight Israeli medical institutions working voluntarily and facilitated by the Jerusalem AIDS Project, in 2008 trained 10% of all surgeons in Swaziland in performing safe, swift circumcisions on adult men to help protect them against HIV infection. Last year, five Muslim Senegalese doctors were brought to Israel to discuss teaming up West African and Israeli medical circumcisors for future training in southern Africa.

Israel is the only country in the world with extensive experience in adult male circumcision, because of the campaign to perform the ritual on large numbers of non-Jewish immigrants from the former Soviet Union and other countries who want to convert to Judaism.

"The whole subject of Israeli excellence in saving lives by promoting male circumcision for HIV prevention could be taken up by American Jewish leaders as the new paradigm for Israel-Diaspora cooperation for global health causes," said Dr. Schenker of the Jerusalem AIDS Project.

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