The following article by the popular science writer, Dr Karl S. Kruszelnicki, in Sydney's Good Weekend provoked a fierce attack from Australia's leading circumcision crusader, Professor Brian Morris.
Circumcision goes back a long way - Egyptian male mummies dating back to 2300BC have been circumcised. Its popularity now varies from country to country - in Australia, between 10 and 20 per cent of newborn males are circumcised each year, compared with more than 60 per cent in the US and less than 2 per cent in Scandinavia. It has long been practised for religious reasons and as a rite of passage in various societies. But there's a (supposed) health issue, too: many parents have circumcised their sons in the belief that it is more hygienic. It's not. As Dr Robert Darby wrote in the Medical Journal of Australia in 2003, "in the days before aseptic surgery, any cutting of the flesh was the least hygienic thing anybody could do, carrying a high risk of bleeding, infection and death."
So how did this myth arise? Wars are very unsanitary, and uncircumcised soldiers were thought to be at risk of serious infection around the foreskin if they couldn't wash frequently. This claim was made in the First and Second World Wars, as well as in both Gulf Wars. In desert wars, it became known as the "sand myth." Dr Ken McGrath, a senior lecturer in pathology at the Auckland University of Technology, could find no evidence to support it. And Sir Duncan Stout, who wrote a chapter on military medicine in the tome History of the Second World War, did not make any reference to circumcision being used to cure foreskin problems. In fact, his official records claimed the opposite - there was a great reluctance to perform circumcisions because the sand in the Sahara Desert was as fine as flour, and was almost impossible to keep out of clothing and away from the skin.
But why remove the foreskin? Dr Paul Fleiss, assistant clinical professor of pediatrics at the University of Southern California Centre, says the foreskin is "a uniquely specialised, sensitive, functional organ of touch." It make proteins that fight bacteria and viruses, and produces a moisturiser that keeps the surface of the glans sensitive, soft and moist. Indeed, it has more specialised nerve endings than any other part of the penis, and is as sensitive as the lips of the mouth.
When did circumcision become linked to hygiene? Probably during the Victorian era, when it was promoted as a way to desensitise the penis to thwart masturbation, which was thought to cause headaches, paralysis, bed-wetting, insanity, epilepsy, tuberculosis, short-sightedness, criminality and heart disease. The hygiene that circumcision was meant to encourage was, it seems, not physical but moral. As far as personal hygiene is concerned, removing the foreskin to have a cleaner penis makes as much sense as removing the eyelid to have a cleaner eyeball.
Karl S. Kruszelnicki, May the foreskin be with you, Sydney Morning Herald, Sydney, NSW, Saturday, 10 January 2004
Good Weekend, 31 January 2004, Your Say
Dr Karl Kruszelnicki ignores the massive scientific support for the benefits of circumcision (Weekender, January 10) and instead presents only extremist anti-circ nonsense from the likes of Paul Fleiss. Dr K fails to even mention that make circumcision prevents a raft of diseases in both sexes, as well as sexual problems in men. Bacteria abound under the foreskin,* accounting for 11-fold higher urinary tract infections. The foreskin is, moreover, an "HIV magnet". Its removal may reduce the risk of AIDS, penile cancer and cervical cancer.
Professor Brian Morris
University of Sydney
Editor's note: In 2002 the Paediatrics and Child Health Division of the Royal Australasian College of Physicians reaffirmed its position that there is no medical indication for routine male circumcision.
Good Weekend, 21 February 2004, Your Say
The letter from Professor Brian Morris criticising Dr Karl Kruszelnicki's article on circumcision, and Morris's claim that it is "only extremist anti-circ nonsense" would best be consigned to the file for academic twaddle. Male circumcision, per se, does not prevent the raft of diseases he lists. Bacteria under the foreskin or anywhere else thrive only because of lack of personal hygiene. As my medico says, the greatest preventive or infection is lots of soap and water.** As for circumcision preventing "sexual problems in men", what bunkum.
E. Armstrong
Coff's Harbour
There is no "massive scientific support for the benefits of circumcision" as Professor Morris alleges in his letter. The only medical reason for it is to treat phimosis (excessively tight foreskin), which affects about 1 per cent of boys.*** With good hygiene there is no increased incidence of HIV-AIDS, penile cancer, cervical cancer or urinary tract infections. The foreskin protects the sensitive glans of the penis and, rather than causing sexual problems, it increases sexual sensation.
Dr Ian Arthur GP
Sawtell, NSW
I am 37, uncircumcised, and have not in my memory had a urinary tract infection or penis/sexual problem due to my well-designed crumpled end bit. We don't remove the appendix just because it may get infected. Why should circumcision be regarded any differently from the practice of female genital mutilation?
Gary Daly
Mosman
* A recent scientific study of the foreskin published in the British Journal of Urology found that sub-preputial moisture consisted of water, shed skin cells, secretions from the prostate, seminal vesicle and urethral glands, various sterols and fatty acids which protect skin surfaces in other contexts, and a variety of benign bacteria – i.e. bacteria which are either harmless or beneficial.
** Soap may not be such a good idea, especially in babies and boys, as it can easily irritate the glans and inner foreskin layer. It's often better just to use water. Further information.
*** Most cases of phimosis can now be treated without the need for surgery. Further information.
Not content with writing a mere letter to the newspaper, Brian Morris tried to use his status as a professor at Sydney University to pressure the university to sack Dr Kruszelnicki from his position as Julius Sumner Miller Fellow in the School of Physics. He also filed a formal complaint of bias against the Sydney Morning Herald with the Australian Press Council. But as the following article in the Herald shows, he was not successful in these efforts to suppress free speech.
Sydney Morning Herald, Tuesday, 13 April 2004
The Australian Press Council has dismissed a complaint by Professor Brian Morris against the Good Weekend magazine, published by the Sydney Morning Herald, over a column by Dr Karl Kruszelnicki. Professor Morris's complaint centred on a regular short column, Mythconceptions, in which Dr Kruszelnicki writes about 400 words on many different subjects which fall into the category of "life's myths, curiosities and absurdities". In particular, Professor Morris complained about a column on circumcision, "May the foreskin be with you", published on 7 January 2004, describing it as "a mischievous anti-circumcision" article and "blatantly biased propaganda".
He said Dr Kruszelnicki was "deliberately deceptive" in not mentioning any of the health benefits of circumcision and criticised one of Dr Kruszelnicki's sources as an "anti-circ activist" and a "hero of the anti movement" who did not have appropriate medical qualifications.
In response, Dr Kruszelnicki, who acknowledged that he is not a urologist,* pointed out that his column did not set out to discuss in detail the pros and cons of circumcision but rather discussed specifically what he saw as "the myth" that circumcision was originally performed for hygiene reasons and how this belief later evolved.
Dr Kruszelnicki named four sources, including the one objected to by Professor Morris. In relation to the latter, Dr Kruszelnicki pointed out he quoted just eight words from that source: the foreskin is "a uniquely specialised, sensitive, functional organ of touch".
The Press Council noted that Good Weekend offered Professor Morris an opportunity to air his views by publishing his letter to the editor on January 31. However, Professor Morris also believed that Good Weekend magazine, in later publishing three letters opposing the views in his letter, demonstrated editorial bias.
Given the nature of the Mythconceptions column and the fact that Good Weekend published Professor Morris's letter, the Press Council said it believed the publication had adequately dealt with the matter.
* Neither is Brian Morris.