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Issues associated with the introduction of circumcision into a non-circumcising society
  1. G J Boyle
  1. Bond University, Gold Coast, Qld 4229, Australia;

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    A team lead by Kebaabetswe propose the introduction of infant circumcision in Botswana, based on:

    • a survey of its acceptability to Batswana (people of Botswana)

    • its practice in certain Western nations, and

    • its alleged value in preventing HIV infection.1

    There are several medical, psychological, sexual, social, ethical, and legal problems with this proposal.

    Medical effects

    Male neonatal circumcision is not an innocuous procedure. There are many complications ranging from trivial to life threatening. Complications generally include bleeding, infection, and surgical accident, including penile necrosis and penile amputations.2 Bleeding or infection can progress to death.3,4 It is difficult to control complications with mass circumcisions.5 Circumcision excises significant amounts of nerve bearing penile skin and mucosa, especially the ridged band structure near the mucocutaneous boundary.6 The protective effects of circumcision against HIV remain controversial.7 UNAIDS has not accepted circumcision as a useful public health measure.

    In neighbouring South Africa, many children are infected with HIV.8 This is attributed to unsafe health care.

    Circumcision creates an open wound through which infection may proceed.9 It is not clear that safe aseptic circumcisions can be delivered in Botswana. It is possible that mass circumcision may worsen the epidemic.

    Psychological effects

    Psychological manifestations of circumcision have been an area of study at Bond University.

    Neonatal circumcision is an intensely painful, traumatic, and stressful operation.10 General anaesthesia is unsafe in the newborn. Available methods of anaesthesia are only partially effective.10

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