Circumcision: Nature or Tradition?

[The title itself shows bias: "Nature" is in this context viewed as wild and in need of taming, "tradition" as benign and trustworthy. Compare "Wholeness or Habit?"]

Posted 10/20/2000
Janet Waldman
drkoop.com Health Correspondent

In the early 1980s, almost 70 percent of parents of newborn boys in the United States elected to have them circumcised. There wasn't much discussion about it. Twenty years later, that figure has dropped to 60 percent, according to hospital statistics compiled by the National Center for Health Statistics. In some areas of the country, there is considerable pressure on parents not to circumcise from nurses and others in the healthcare field. [There is still, as there has long been, considerable pressure on them to circumcise, and since intactness is an ongoing state, the pressure may show no let-up until it is done.]

The United States is the only country in the world that routinely circumcises most of its male infants in the hospital for nonreligious reasons. More than 80 percent of the world's males are intact, meaning they retain their foreskins. In 1996, the most recent year for which circumcision figures are available from NCHS, the Midwest led the country in newborn circumcisions with 81 percent, followed by the Northeast with 67 percent and the South with 64 percent. The West trailed with 36 percent. [In other words, the West leads the country in intactness.]

Many Different Reasons
The American Academy of Pediatrics last year made what some have termed a "wishy-washy" policy statement regarding circumcision. The statement, in the March 1999 issue of Pediatrics, read:

"The existing scientific evidence demonstrates potential medical benefits of newborn male circumcision. However, these data are not sufficient to recommend routine neonatal circumcision. Parents should determine what is in the best interest of the child. [In a recent book, a Canadian ethicist is critical of this position.] To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. It is legitimate for parents to take into account cultural, religious and ethnic traditions. [It is illegal to take such traditions into account if the child is a girl. Why the double standard? The Canadian ethicicist makes a similar point.] If a decision for circumcision is made, procedural analgesia should be provided."

Dr. Josh Copel, chief of perinatology at Yale Medical School in New Haven, Conn., and "Now That You're Pregnant" columnist for drkoop.com, thinks boys are better off being circumcised as infants than as adolescents or adults. [As usual, the option of leaving their genitals alone is ignored.] He sees a number of private patients and many clinic patients as an OB-GYN and performs circumcisions on a rotating basis with other doctors at the hospital.

To be sure, there are pros and cons. A circumcised penis is [very slightly] easier to clean because the foreskin does not have to be retracted to clean out the smegma, a natural secretion. If smegma is not removed, the penis can become infected, or strictures (scar tissue that builds for years) can form, affecting sexual function, according to Copel. [Scar tissue is a result of forcible retraction.] Other reasons parents cite for choosing to circumcise include wanting their son to look like his father, and to resemble his contemporaries in the locker room. [In the West, that will be achieved by leaving him intact.]

Research shows circumcised males are less likely to develop AIDS or penile cancer, but Copel and urologists are quick to point out that penile cancer is rare, and that is not enough to justify circumcising all males. An exhaustive look at the practice of circumcision in the United States was recently published in the Journal of the American Medical Association and stated that there is no difference between circumcised and uncircumcised men when it comes to their risk of sexually transmitted diseases.

Is It the Parent's Decision?
Those opposed to circumcision say boys should be able to make up their own minds when they are older about the procedure that removes the foreskin, and that when parents do the deciding, they deprive their sons of several advantages. Some say removal of the foreskin results in diminished sexual pleasure. Men circumcised as adults report a significant loss of sensitivity. Others call it "male genital mutilation" and say it's just not natural. [More to the point, we say it's a human rights abuse.] If it is done without anesthesia, critics say it causes newborns unnecessary pain for cosmetic reasons.

Statistics from the National Center for Health Statistics show that 81 percent of white newborn boys, 65 percent of blacks and 54 percent of Hispanics are circumcised for a total of 1.2 million newborns annually, at a cost of between $150 and $270 million.

Copel said most parents are swayed toward circumcision for religious reasons -- all Jewish boys are circumcised, for example [Not so.]-- or because the father wants the boy to look like him. He noted the reimbursement rate from insurance companies averages between $7 and $140. "It's not something we do to get rich," Copel said.

During the process, which takes about five minutes in the hospital nursery [If it takes only five minutes, then they haven't allowed nearly enough time for the anaesthetic to take effect.], the infant is secured with Velcro straps so he will not move around. "In that position, being held down, they usually cry anyway. They cry a little when we numb the penis with a needle. They know we are doing something, but I assume they just feel they are being manipulated. For a day or two, they need gauze and petroleum jelly, then they are just fine," Copel said.

[Here are more details about the operation.]

Dr. Alan Davidson, chief of urology at Milford Hospital in Milford, Conn., said circumcision had many benefits in the 19th century [even that is debatable], but "in the clean environment that exists in this country, it's a wash whether you are circumcised or not. People get along either way. It's a personal choice." [But he glosses over who is the person choosing.] About 90 percent of newborn boys are circumcised at Milford Hospital.

His daughter-in-law recently gave birth to his first grandson in California. "The pressure on her not to circumcise him, from nurses mostly, was tremendous. They said, 'How can you do this to your little boy?' People are into natural things now, natural childbirth, breast-feeding and so on," Davidson said. The Davidsons are Jewish, and the baby was circumcised.

"To me, circumcising infants is fast, easy and it's done with a little clamp, and there's a very low complication rate. In older males, it's surgery. [It's ALWAYS surgery.] Moms are told it's more natural not to circumcise, but then they don't get any support on the hygiene routines required to care for an uncircumcised penis," he said. [Which are very minimal. DrKoop.com itself gives misleading advice.]

Dr. Chris Fletcher, a member of Doctors Opposing Circumcision, conducted a national survey in which he found that only 52 percent of doctors educate parents about circumcision.

As for putting the infant through trauma, Davidson said: "The whole birth process is traumatic. The baby's head gets crushed [No, the very flexible bones flex and the wide sutures open and close to suit] and they look funny for three days after their trip through the birth canal." [If that is painful - and it probably is not - whatever we can do to reduce the trauma of birth, we do. Circumcision is unnecessary trauma.]

According to the Circumcision Resource Center Web site, studies that have found that short-term [months- later] effects of circumcision include changed activity level, sleep patterns and mother-infant interaction, as well as increased irritability and disruptions in feeding and bonding. Long-term [decades -later] effects have not been studied.[Taddio et al. found the reaction to vaccination months later was different. That's pretty long-term in the life of a newborn.]

Room for Error
David Migliaccio of Southbury, Conn., is among the majority of babies in Connecticut circumcised a few days after birth. The procedure was done in the Waterbury, Conn., hospital where he was born this past summer. His parents, Melissa and Mark Migliaccio, signed the consent form. They did not discuss the procedure with their pediatrician or obstetrician, nor were they given any literature.

They are also the parents of an older son, Andrew, who had been circumcised as a newborn as well, with no problems. An anesthetic was used during both the boys' circumcisions.

Once David came home and Melissa and Mark began to change his diapers and bathe him, they discovered that David only received what his mother describes as "a partial circumcision," or one in which all the foreskin was not removed.

"We still need to push it back to clean underneath it, which was one of our main reasons for having the procedure done. At this point, there is nothing to be done unless we want to put him under a general anesthetic to have the procedure completed, which we do not want to do," said Melissa.

She feels the physician made a mistake on David, but has not owned up to it. She and her husband are very disappointed.

Circumcision complications can include damage to the penile shaft, damage to the urethra, unsightly postoperative appearance and, in rare cases, death. However, the most common complications are mild bleeding and local infection, according to the AAP. When parents decide to circumcise later, the child is given general anesthesia and it is a hospital procedure. Davidson does a couple per year. Adults are given a local anesthetic in the doctor's office at the base of the penis. [ smile The Doctor is IN!]

There are times when circumcision is contraindicated, Davidson said. If the genitalia are abnormal and the foreskin may need to be used to repair a problem later, it is best to leave it intact. He mentioned that boys who have a urological anomaly are at greater risk of infection when they are uncircumcised, [...and when they are circumcised: an anomaly is an anomaly] and that infections can lead to urinary problems.

Davidson said the foreskin will strip back by itself eventually, but moms of newborn boys must strip it back themselves and clean it during every bath.

[No! This is false and dangerous. They must NOT do this.]

Circumcision is an option [whose option?], not a rule, according to drkoop.com health columnist Dr. Nancy Snyderman. She thinks it should not be done without a thorough discussion between parents and doctor. While circumcision will continue to be a religious rite for some (those of Jewish faith have rabbis perform the circumcision on newborn boys), it is not a mandate for others. Her advice: Talk it over with your pediatrician, weigh the pros and cons against your beliefs, and don't succumb to pressure from well-meaning relatives and friends. [...and consider the ethics of removing healthy, erogeous tissue from a newborn baby, who may well grow up to wish he still had it.]


The original of this article is at http://drkoop.com/family/childrens/feature.asp?id=6335

Former US Surgeon-General E. Everett Koop was reputedly a rampant circumcisor who seldom let a boy escape his clutches intact.

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