divine_msn - "WTH is wrong with delaying the procedure until the boy is old enough to agree to it, the organ somewhat/much larger, the child/youth much more able to withstand the insult of a GA and be given appropriate analgesia to maintain post-operative comfort?"

Jakew - "Well, there are fewer medical benefits, higher risk of complications, time off work/school, period of abstinence from sex, poorer cosmetic outcome, embarrassment and anxiety about pain, effects."

Jakew - I think we've established the 'medical benefits' of circumcision are few and far between.

I can assure you the risk of complications are considerably fewer due to the reasons given above.

Time off school/work? Maybe 3 days? Presumably these boys/young men have time off. For instance - 2 of my children needed wisdom teeth removal under GA. Procedures were booked early in school holidays.

Abstinence from sex? Dearie me! Most men are able to resume sexual activity after 2 weeks. Some sooner (against advice but without ill effect) if healed. Should we get worried about 'blue balls'? I don't think so ...

Poorer cosmetic outcome? Quite the opposite - since much of the disfiguring damage done during neonate circumcision is simply because the operator does not have much to work with. Even a 'minor' slip can have devastating consequences. Also in the very young male - up to 3 years and often older, the foreskin is adherent to the glans and must be 'peeled' away leaving a raw surface increasing the risk of removing too much skin (a 'tight' circumcision), formation of skin bridges during the healing process and scarring - especially if infection occurs. Where the foreskin has naturally retracted in the older boy/youth/man that part of the procedure is eliminated and the 'cosmetic' (strange you should be worried about that though, since disfigurement of the very young seemingly does not qualify) effect is generally excellent.

Continued next post ...

Continued ..

Embarrassment & anxiety? Dearie me again! If a boy/youth/man is convinced of the benefits of circumcision then despite any apprehension about baring his genitals for inspection to the good doctor chosen for the job, he'd still have it done. I can guarantee jakew, that the candidate would be reassured by the surgeon and promised post-operative high level pain relief as needed to remain comfortable. Infants however are often lucky to get paracetamol.

On the other hand I can tell you the 2 men I know personally (because one is a relative and the other a cousin of a cousin) who have mutilated penises due to infant circumcison performed badly have suffered EMBARRASSMENT & ANXIETY about their condition since they realised the state of their organs. More than that, it has impacted their entire lives - especially relations with women. The elder of these unfortunate gentlemen is in his 50s. He is missing approximately 1/3 of his glans. He has never married or been in a long term relationship and has fended off women who have been attracted to him. The younger is now in mid 20s and had several childhood surgeries to try repair some of the damage. They moved to Perth WA and I've lost touch but when the lad reached his teens his parents went through a very torrid time with his mental state and anguish over the injury and what it may mean for him as an 'adult man', fearing he would ultimately suicide. There was a lot of speculation shortly after the botch up whether he would have a 'functional penis' later in life. I believe the Urologist was optimistic but malformation was gut wrenching. I guess those guys would have preferred the higher risk of penile cancer in their 60s or 70s had they had the choice.

My knowledge is largely gained from experience. If you can provide some valid evidence for your arguments why circumcision shouldn't be delayed until the owner of the penis is able to participate in the decision - please do.

To reply to divine_msn:

"I think we've established the 'medical benefits' of circumcision are few and far between." -- if we did, I'm afraid I hadn't noticed.

"I can assure you the risk of complications are considerably fewer due to the reasons given above." -- assure as much as you like, but you're wrong. A recent systematic review found typical complication rates of 1.5% when performed in the neonatal period, and 6% when performed later on. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2835667/?tool=pubmed

"Presumably these boys/young men have time off." -- I didn't say that this made it impossible, just that it's a disadvantage to wait. As with many of the other disadvantages that I listed.

Regarding cosmetic outcome, you seem to be overlooking the facts that sutures are not needed in neonatal circumcisions, and that would healing is remarkable in the very young. These tend to produce less scarring. A relatively minor point, but it would be foolish to consider any one point in isolation: they must be considered as a whole.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2835667/?tool=pubmed

Dear jakew. This article like many concerning circumcision is skewed, quite frequently comparing apples with oranges. Trying to compare rates of complication - even defining what constitutes a complication between modern western surgical settings and practices in 3rd world countries, some involving traditional 'doctors' and non-aseptic technique makes any sort of statistical accuracy impossible. Fail.

I stand by personal experience, even though it is limited to approx 50 late circumcisions of boys aged from about 8 through to an elderly gentleman in his mid 70s. No complications apart from minor bleeding and swelling and cosmetically all good. What's more - apart from the under 12s - every one of them, for whatever reason, was having the procedure of their own free will.

I'm not anti-circumcision, rather anti FORCED circumcision and anti ALL unnecessary medical and surgical interventions. If "medical reasons" are the "valid" indicator for circumcision why not offer systemic unchallenged removal of tonsils, adenoids and appendix? Pesky useless little organs causing much trouble and misery to so many kiddies and adults ... Why not whip em out before the baby leaves the hospital? What's that I hear? Unethical to remove healthy organs? Oh dear - that excludes circumcisions then ...

Circumcision is predominantly a religious rite within the Jewish and Islamic faiths or a religious/cultural rite common in African tribes performed chiefly to mark 'coming of age'. Australian aborigines - or at least some tribes, did likewise. Its place in Western medicine came about because some shonky Doctor saw easy money in introducing the practice as a cure for all sorts of things including masturbation, bedwetting and tuberculosis. "Medical Reasons" of course that were ficticous but many believed and I'm sure he died a very wealthy man. Scores of medicos since have continued to profit from the procedure as now it's just an accepted commonplace thing. Oh I do support them. So long as, like all cosmetic procedures, they perform circumcisions on informed, consenting individuals other than the rare case of medical need.

To respond to divine_msn:

"This article like many concerning circumcision is skewed, quite frequently comparing apples with oranges." -- but you haven't produced a persuasive argument against it.

"If "medical reasons" are the "valid" indicator for circumcision why not offer systemic unchallenged removal of tonsils, adenoids and appendix?" -- the balance between risks and benefits is different.

There is NO evidence that infant circumcision has ANY effect on HIV or HPV transmission in adulthood. Loving parents will take the path of least risk and least intervention. And protect their little boys by teaching them how to keep themselves clean, to practice safe sex when the time comes and to respect the rights of others.

Medical ethics involve all 4 elements: unequivocal beneficence for the individual patient, nonmaleficence, justice and autonomy of the patient, not his parents.

Foreskins and frenula are sensitive sexual organs and cannot grow back.

Identifying trimming fingernails with forced circumcision is pathetic.