To cut or not to cut?

THE Muslim community in Ireland is currently putting a proposal before the HSE aimed at tackling the problem of long waiting lists for cultural circumcision for their male children.

The community, of which there are about 30,000, with two-thirds in Dublin, wants circumcision to be done in a medical centre by a Muslim doctor trained to perform the procedure on infants usually under eight weeks of age.

For people of Islamic faith, circumcision — a procedure in which a portion of the foreskin is removed from the penis — is important because it symbolises hygiene and purification.

Alf Nicholson, professor of paediatrics at Temple Street Children’s Hospital, says cultural circumcision tends not to be prioritised within our health system. “It’s not like an operation that needs to happen because the child will get sick without it.”

He is aware of parents who are distressed by the long waiting lists. “They could be waiting for many months, even years.”

In 2011, more than 2,000 paediatric circumcisions were performed in acute public hospitals in Ireland. The procedure is available in most public hospitals and, if carried out in such a setting, there’s no cost to parents. If performed privately, parents can pay in around €900. The majority of male paediatric circumcisions carried out here are culturally motivated.

Sri Paran, a paediatric consultant surgeon at Crumlin Children’s Hospital, estimates that 500 to 600 circumcisions are carried out there annually, with 85%-90% done for cultural reasons. “It’s not just done for religious reasons,” he says. “Some parents come from an area where circumcision is done. Nigerians, many of whom are Catholic, prefer to have it done. People from the Philippines, who for the most part are Catholic, carry out circumcision on their males. At one time, almost 90% of US males were circumcised.”

In Britain, rates of circumcision have declined sharply since the 1930s and ’40s, when it was almost the done thing for sons of financially well-off parents to have it done. Such routine circumcision never caught on in Ireland. “There is no such thing as a cultural background for circumcision among the Irish. We won’t see them at our clinic unless there’s a medical indication. When parents hear circumcision will solve a child’s medical problem, they’re very glad,” Dr Paran says.

Some research suggests that male circumcision may have a knock-on health benefit for women. Asem Hamdy, consultant surgeon in gastrointestinal medicine and urology at Kerry General Hospital, points to studies that suggest presence of the foreskin can cause a slight increase in incidence of cervical cancer in women.

“In societies where most of the men are circumcised, women of circumcised partners have a lower incidence of cervical cancer. There’s no confirmation as to the mechanism behind this.”

Mr Hamdy says circumcision may reduce cancer of the foreskin in older men. “When adults get recurrent infection of the foreskin, the foreskin starts to get tougher. It thickens and cracks appear — this is a pre-cancerous condition.”

The procedure is not without risks — potential complications include bleeding and infection. David Smith is manager at Norm-UK, a group helping men damaged physically and psychologically through circumcision. It also helps men who have problems with their foreskin to find solutions other than circumcision. Smith says the foreskin isn’t just redundant tissue but an essential part of the penis.

“Its loss can and does cause problems — problems with sexual intercourse, with dryness, with sensitivity. Psychologically, men can feel awkward because they look different.”

He questions the claim that circumcision prevents HIV infection. “In the US, where there’s a high circumcision rate, there’s a very high HIV rate, yet Sweden — with its low circumcision rate — has a low HIV rate.”

While Norm-UK doesn’t take issue with circumcision when performed for genuine therapeutic reasons, the organisation believes “it should be the owner of the body who chooses whether it’s modified or not”.

Smith says: “It shouldn’t be anybody’s right to amputate a healthy part of the body without the child’s informed consent.”

For millions, however, circumcision remains a core part of their religious and cultural lives.