Ch. 8: The Distribution of Male Genital Integrity (DOC Genital Integrity Statement)

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This is Chapter 8 of a statement available at http://www.doctorsopposingcircumcision.org/DOC/statement0.html

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Chapter Eight: The Distribution of Male Genital Integrity

Wallerstein (1985) estimates the overall worldwide incidence of male genital integrity at about 80 percent.1 The incidence of genital integrity varies enormously from nation to nation.1

Non English-Speaking Nations

The incidence of genital integrity is very low in Israel, where most boys are circumcised on the eighth day of life.

The incidence of genital integrity also is very low in Turkey2 and other Muslim nations, where boys are usually circumcised between ages four and twelve.

Europe has had a very high incidence of genital integrity,1 however, the increasing immigration of Muslim minorities is lowering the incidence of genital integrity in Europe. Sweden, like other Scandinavian nations, does not usually practice male circumcision. Even among Jews, the incidence of circumcision is relatively low. Hofvander (2002) reports only about 40 percent of Swedish Jews practice ritual circumcision,3 leaving 60 percent with intact genitals.

Latin America does not practice non-therapeutic genital cutting of boys, so the incidence of genital integrity in Latin America is very high.

Russia and China, except for Muslim areas, do not practice male circumcision, so the incidence of genital integrity is very high.1

In South Asia, Muslims practice circumcision, but Hindus, Sikhs, Buddists, and others do not, so those groups have a very high incidence of genital integrity.

The Philippine Islands have a very low incidence of genital integrity because circumcision (called tuli) is a social practice.4

South Korea, because of American influence, also has a very low incidence of genital integrity.5 Kim et al. (1999) report a genital integrity rate of only 16 percent among males aged 16-29.5

English-Speaking Nations

The English-speaking nations, alone in the world, have practiced male neonatal circumcision for putative prophylactic purposes for more than one hundred years.1

The British National Health Service stopped providing non-therapeutic circumcision in 1950, so the incidence of genital integrity has greatly increased in the United Kingdom. The 2000 British National Survey of Sexual Attitudes and Lifestyles (Natsal 2000) placed the incidence of genital integrity among 16 to 19-year-old males at 88.3 percent.6 Men of ethnic minorities (except black Caribbeans) were significantly more likely to be circumcised than those described as “white”.6 Jews in Britain had the lowest incidence of genital integrity at 1.3 percent, but Sikhs, Buddists, and Hindus had an incidence of genital integrity of 98.2 percent.6

Canada has practiced circumcision, but the practice is in decline all across the country. Patel (1965) reported the incidence of circumcision at one hospital in one city to be 48 percent in 1961-2, which would produce an incidence of genital integrity of 52 percent.7 This four-decade-old figure has been improperly used by the American Academy of Pediatrics to represent the incidence of circumcision in all Canada.8 In any event, it is inaccurate and outmoded. The Canadian-based Association for Genital Integrity reports that the incidence of genital integrity among boys born in 2003 varied from a high of 100 percent in Newfoundland to a low 70.5 percent on Prince Edward Island.9 It estimates the overall incidence of genital integrity among Canadian boys, born in 2003, to be 86.1 percent in 2003, with a trend toward increased genital integrity.9

Australia has a high incidence of genital integrity among newborn boys because the official policy of the Australian College of Paediatrics, since 1971, has been to discourage circumcision of newborn boys.10 Wallerstein (1985) reported the incidence of genital integrity in Australia at about 51 percent in 1973-4 and about 61 percent in 1979-80.1 In 2000, only about 52 percent of all Australian males were genitally intact because of the previous high incidence of circumcision.11 Darby (2000) reported that the incidence of genital integrity among newborn boys in 1995-6 was 89.4 percent. The incidence of genital integrity among newborn Australian boys has held steady at about 87.2 percent in recent years but varies sharply from state to state, with a low of 82 percent in Queenland and a high of 98 percent in Tasmania.12

New Zealand formerly had a low incidence of genital integrity, but in about 1970, the rate of circumcision started to decline sharply, so the incidence of genital integrity has been increasing. New Zealand has increased the incidence of genital integrity among newborn Caucasian boys to more than 99.5 percent,13,14 The Polynesian Pacific Island (mostly Samoan and Tongan) people have a low incidence of genital integrity, approaching zero percent.14 The indigenous Maori people respect and maintain genital integrity.13,14

The United States has the lowest incidence of genital integrity among English-speaking nations,1 but the trend is toward increased genital integrity. A study carried out in five Pittsburgh hospitals in the early 1960s found that 97 percent of the infants were circumcised, leaving only 3 percent with intact genitals.15 Laumann et al. (1997) reported results from the National Health and Social Life Survey (NHSLS), which surveyed males born from 1932 through 1971.16 The NHSLS found that the incidence of circumcision peaked at 85 percent in 1965, which would produce a genital integrity incidence of 15 percent. Of males born in the U.S., 23 percent had intact genitals. Among males born outside the U.S., 67 percent had intact genitals.14 The National Hospital Discharge Survey (NHDS) reports that, in 2006, the overall incidence of genital integrity in the United States among newborn boys was 44 percent.17 The NHDS also reports the incidence of genital integrity by four census regions. There was substantial regional variation with the incidence of genital integrity ranging from a low of 22 percent in the North Central Region to a high of 66 percent in the Western Region.17 There has been a year-to-year trend toward increased genital integrity among newborn boys in all four U.S. census regions.17

Nearly one hundred percent of boys in Islamic nations are circumcised. The circumcision, however, usually occurs at from five to twelve years of age.18 The United States and Israel are the only two nations that circumcise a majority of boys in the newborn period. The United States is the only nation that circumcises a majority of boys in the newborn period for non-religious reasons.

References

  1. Wallerstein E. Circumcision: the uniquely American medical enigma. Urol Clin North Am 1985;12(1):123–32. [Full Text]
  2. Verit A. Circumcision phenomenon in Turkey as a traditional country: from past to present. European Urology Today 2002;13(3):4–5. [Full Text]
  3. Hofvander Y. Circumcision in boys: time for doctors to reconsider. World Hosp Health Serv 2002;38(2):15–17. [Full Text]
  4. Ramos S, Boyle GJ. Ritual and medical circumcision among Filipino boys: evidence of post–traumatic stress disorder. In: (Eds) George C. Denniston, Frederick Mansfield Hodges, Marilyn Fayre Milos. Understanding Circumcision; A Multi-Disciplinary Approach to a Multi-Dimensional Problem. New York: Kluwer Academic/Plenum Publishers, 2001.
  5.  Kim DS, Lee JY, Pang MG. Male circumcision: a South Korean perspective. BJU Int 1999;83 Suppl 1:28-33. [Full Text]
  6. Dave SS, Johnson AM, Fenton KA, et al. Male circumcision in Britain: findings from a national probability sample survey. Sex Trans Infect 2003;79:499–500. [Full Text]
  7. Patel H. The problem of routine infant circumcision. Can Med Assoc J 1966;95:576–81. [Full Text]
  8. Task Force on Circumcision. Circumcision Policy Statement, Pediatrics 1999;103(3):686–93. [Full Text]
  9. Circumcision Practices in Canada. Association for Genital Integrity 2003. Available at: http://www.courtchallenge.com/refs/yr99p-e.html
  10. Belmaine SP. Circumcision. Med J Aust 1971;1:1148. [Full Text]
  11. Darby R. “A source of serious mischief”: The demonization of the foreskin and the rise of preventive circumcision in Australia. In: (Eds) George C. Denniston, Frederick Mansfield Hodges, Marilyn Fayre Milos. Understanding Circumcision; A Multi-Disciplinary Approach to a Multi-Dimensional Problem. New York: Kluwer Academic/Plenum Publishers, 2001: p. 157.
  12.  Young H. Circumcision in Australia. (2005) Available at http://www.circumstitions.com/Australia.html.
  13. McGrath K. Young H. A review of circumcision in New Zealand. In: (Eds) George C. Denniston, Frederick Mansfield Hodges, Marilyn Fayre Milos. Understanding Circumcision; A Multi-Disciplinary Approach to a Multi-Dimensional Problem. New York: Kluwer Academic/Plenum Publishers, 2001.
  14.  Young H, McGrath. The Rise and Fall of Circumcision in New Zealand. Presented at the Sixth International Symposium on Genital Integrity, Sydney, December 8, 2000. Available at URL: http://www.circumstitions.com/NZ.html
  15. Thompson DJ, Gezon HM, Rogers KD, et al. Excess risk of staphylococcus infection and disease in newborn males. Am J Epidemiol 1965;84(2):314–28.
  16.  Laumann, EO, Masi CM, Zuckerman EW. Circumcision in the United States. JAMA 1997;277(13):1052–7. [Full Text]
  17. National Hospital Discharge Survey for 2006. Hyattsville, MD: National Center for Health Statistics.
  18.  Sahin F, Beyazova U, Akturk A. Attitudes and practices regarding circumcision in Turkey. Child Care Health Dev 2003;29(4):275. [Abstract]

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