Jane McCredie: Cut the rhetoric

MEDIEVAL churches used to engage in vigorous argument over which of them owned the “authentic” foreskin of the circumcised Jesus Christ, the only part of him believed not to have ascended bodily to heaven after the resurrection.

At one point, as many as 18 churches are supposed to have asserted theirs was the genuine holy prepuce, with no clear winner ever established.

Catherine of Siena even claimed in the 14th century to be wearing the foreskin on her finger as a ring given to her by Jesus when he made her his bride, though apparently nobody else could see it.

It seems the ability of foreskins to cause trouble has not waned over the centuries as this week’s MJA clearly demonstrates.

An editorial published by the journal last year advocating infant circumcision as a preventive health measure, particularly for later protection against heterosexual transmission of HIV, caused a storm of protest among letter writers.

Non-therapeutic infant circumcision could be seen as “tantamount to criminal assault”, says one of the letters published in the Journal’s Matters Arising this week, while another describes it as “a highly mutilating operation which seriously impairs penile function”.

It’s citations at 10 paces, as the letter writers and authors of the original paper launch research claims at each other in an attempt to prove their positions.

Pity the poor parents of a newborn son trying to make sense of it all.

Could early circumcision help prevent him from later exposure to HIV or are the findings only valid for African men circumcised in adulthood?

Might his circumcision actually increase the risk of transmission to his female partners if he was unfortunate enough to contract the virus?

And would the hapless parents be dooming him to a life of dulled sensation and impaired sexual performance if they went ahead?

It seems whenever penises are involved, it doesn’t take long for things to get heated and claims to become, well, a tad exaggerated.

Clearly, there is an argument against removal of any healthy tissue in the absence of a medical indication, particularly in a minor who is incapable of consent.

Cultural factors aside, there might also be an argument in the other direction if public health benefits could be demonstrated and if delaying the procedure until the patient was capable of consent was associated with a clear reduction in benefit or increase in risk.

But the intemperate nature of the arguments made by some in both the pro- and anti-circumcision lobbies doesn’t really do anybody any favours.

I suspect few circumcised men would welcome suggestions they had a “mutilated penis”, and most would probably respond to any suggestion that their sexual function was impaired with: “Nothing wrong in that department, thanks very much”.

The Catholic Church eventually became so frustrated with the arguments over the holy foreskin that last century it apparently decreed any further discussion of the elusive scrap of tissue would lead to excommunication.

Medical debate is not so easy to silence ― and nor should it be ― but it might be in everybody’s interest if we could rein in the rhetoric and discuss a complex issue in less emotive terms.

Jane McCredie is a Sydney-based science and medicine writer. She has worked for Melbourne’s The Age and contributed to publications including the BMJ, The Australian and the Sydney Morning Herald. She is also a former news and features editor with Australian Doctor. Her book, Making girls and boys: inside the science of sex, will be published by UNSW Press next month.

Posted 17 January 2011