12 Reasons to Say “No” to
Circumcision
By Tara Bzdok
Circumcision
is a very controversial and emotionally charged topic. Even
doctors have their personal feelings about
the procedure — and
unfortunately, they do not all agree. A doctor advising circumcision
of a healthy infant for any reason is going against the recommendations
of the American Medical Assocation (AMA), the American Academy
of Family Physicians (AAFP), the American Academy of Pediatrics
(AAP), the American College of Obstetricians and Gynecologists
(ACOG), the Canadian Paediatric Society (CPS) and every other
medical association in the world.
1.
Circumcision removes vital skin structure and function. The
foreskin is not just unnecessary skin. It
is an important, complex
structure that contains an elaborate network of nerve endings,
making up about half of the erogenous tissue of the penis. The
foreskin’s purpose during infancy is to protect the glans
(the part of the penis inside the foreskin) from infections from
urine and feces. In adulthood, it enhances sexual pleasure due
to the intact erogenous tissue and provides lubrication for the
man’s sexual partner.
2.
Circumcision hurts. In a hospital circumcision, a doctor
or intern straps the infant onto a board and (usually) injects
or applies a topical anesthetic to the area. After forcing the
foreskin to separate from the glans, the doctor clamps the foreskin
in a plastic ring or clamp and then cuts it off.
When
American doctors performing circumcision finally realized that
infants had the ability to feel pain
(not until 1989!),
they began using local anesthesia, which poses toxicity threats
if the dose is not right in a tiny infant. Since infants actually
feel pain more acutely than adults and general anesthesia is
too dangerous for use on infants, the pain is merely “reduced,” not
eliminated. Studies have shown that babies who do not cry during
the procedure may be in a state of shock due to overwhelming
pain. The healing process is also very painful, since the wound
is constantly in contact with a diaper.
3.
No medical organization in the world recommends circumcision. About 18 deaths occur per 100,000 circumcisions,
with the rate
of complications, including staph infections and even loss of
the penis, running about 6 percent. Although the American Academy
of Pediatrics (AAP) leaves the decision to circumcise up to a
child’s parents, they do state that the procedure is not
medically indicated — in other words, the “potential
benefits” do not outweigh the risks. In the AAP/American
College of Obstetricians and Gynecologists (ACOG) guidelines
for perinatal care, doctors are instructed to provide new parents
with “accurate and unbiased information on circumcision,” including
the fact that it is not recommended and usually including instructions
on the care of the uncircumcised penis.
4.
Circumcision violates infants’ rights. Before deciding
on circumcision you may want to consider your son’s rights.
An article published in Humane Health Care International
explains that circumcision of infants is a violation of the seven
principles
of medical ethics. Following the United
Nations Convention on the Rights of the Child in 1989,
the AAP Committee on Bioethics stated that parents have the right
to grant permission for diagnosis and treatment, but they do
not have the right to decide on elective procedures for their
children. These should be postponed until the child is able to
choose them for himself. The committee also mentions that parents’ rights
to force religious practices that could be harmful to the child
should be limited. In contrast, the AAP official policy statement
allows the parents to make the decision.
In
western countries, it goes without saying that female genital
mutilation (FGM), a practice common in
Islamic nations and Africa,
is unethical, cruel and illegal. Any comparison to circumcision
of males seems preposterous — or does it? Actually, the
two procedures stem from similar cultural practices. In its “milder” forms,
FGM is no more dangerous than the circumcision of males.
5.
Circumcision is traumatic. Neonatal circumcision has been associated
with disturbances in maternal bonding,
breastfeeding
and sleep of the infant. Numerous studies have shown that a person’s
birth experience can have psychological and emotional effects
throughout his or her life. One study shows that circumcised
men may have reduced thresholds for pain. In a Canadian study,
circumcised boys showed greater pain responses while being vaccinated — symptoms
of Post Traumatic Stress Disorder (PTSD).
6.
Circumcision rates are declining all over the world. Globally,
about 20 percent of men are currently
circumcised. America has
the highest rate of neonatal circumcision (60 percent) of any
Western country, down from 90 percent in the 1970s. Ninety-nine
percent of these procedures are not done for religious or therapeutic
reasons. The next highest rate of neonatal circumcision is found
in Australia at 12 percent, down from 50% in the ‘70s.
According
to the National Center for Health Statistics, circumcision
in America has been on a steady decline for the
past 25 years
and will catch up to the rates of other English-speaking countries
in about 12 years. The decline in the rates in English-speaking
countries began after an essay published in The
British Medical Journal in
1949 declared it medically unnecessary. It was never popular
in continental Europe, Russia or South America. Areas with high
rates of circumcision include the Middle East, Africa, Islamic
regions of Asia, Polynesia, the Philippines and Fiji.
Many Jews in various nations are now performing a non-cutting
alternative ceremony to the traditional Brit Malah (circumcision
ceremony). They call it Brit Shalom, and even girl children are
being honored in this way.
7.
Circumcision is expensive. The International
Coalition for Genital Integrity claims that each state
could save around $1 million a year by not funding circumcision
of infants. The 16 states no longer funding the essentially cosmetic
procedure are Arizona, California, Florida, Idaho, Louisiana,
Maine, Minnesota, Mississippi, Missouri, Montana, Nevada, North
Carolina, North Dakota, Oregon, Utah and Washington. Many private
insurance companies have also ceased to fund the procedure.
8.
Circumcision is not necessary to prevent urinary tract infections
(UTIs), which can be treated with antibiotics or breastfeeding. Your doctor may have told you that circumcision is important
for preventing urinary tract infections (UTIs). However, UTIs
are not serious enough to warrant preventive surgery. UTIs are
easily treatable with antibiotics, and studies have shown that
breastfeeding is a great for prevention as well as for treatment.
UTIs are only slightly more common (about a 1 percent risk increase)
among uncircumcised boys, about 1 in 100 will be affected. They
can be prevented by proper hygiene and care of the foreskin and
penis.
9.
Circumcision’s role in reducing cancer
rates is negligible, at best. Many studies have linked circumcision
to lower rates
of penile as well as cervical cancer. The incidence of penile
cancer in America is about 1 in 100,000, usually occurring in
older men.
According to the AAFP, circumcision has only been shown to reduce
the cancer risk by about .2%. Proper hygiene and safe sexual
practices are believed to be the most important preventive tool
for penile cancer. The American Cancer Society stated in 1996
that circumcision should not be performed to prevent cancer.
The main causes of genital cancer are smoking, sex at an early
age and unprotected sex with multiple partners.
10.
Studies showing that circumcision reduces the risk of contracting
AIDS have not been duplicated in the
United States. Circumcision
has been shown to work miracles by reducing a man’s risk
of contracting AIDS in studies performed in Africa. If these
studies are valid, how is it that America has both the highest
circumcision rate of any western country and also the highest
AIDS rate? More studies will be concluded in 2007, perhaps shedding
some light on this apparent paradox. Circumcision has also been
linked to reduced rates of ulcerative sexually transmitted diseases
such as syphilis and genital herpes, but the AAFP states that
good hygiene and safe sex could be just as effective. If a sexually
active, adult male feels that his lifestyle choices warrant the
procedure, he may decide to have it done when he is of legal
age to make that decision.
11.
An uncircumcised penis is easily cared for. It seems that the
problems that people blame on foreskins actually
stem from
improper care of the uncircumcised penis. To quote the AAP, “… good
personal hygiene would offer all the advantages of routine circumcision
without the attendant surgical risk.” Since the AAP gives
no instruction in the matter, many doctors advise parents to
force back the foreskin and clean underneath. Actually, the best
mode of action is to leave it alone. A soak in a warm bath is
all it needs during infancy. As the boy grows, the foreskin will
naturally separate from the glans (somewhere between the ages
of 3 and 13), and he may then pull it back and clean underneath
it with clear water. The full process of separation is usually
finished by age 18. Forcing the foreskin back before it is time
can cause tearing and scarring, which can lead to phimosis, or
a tight foreskin that is difficult to retract and sometimes painful.
12.
Sons don’t mind if they don’t look like their
fathers. “Looking like Dad” seems to be the most
important reason to circumcise in America — but how similar
is a tiny, prepubescent penis to Dad’s, anyway? Toddlers
are smart. Try explaining that everyone is unique and body parts
all look different. Tell him that Dad had to have an operation
on his penis but now it is okay. After all, you already have
to explain why Mom looks different, don’t you?
© Tara
Bzdok
Circumcision Resources
Blogs on Circumcision
http://tertia.typepad.com/so_close/2004/12/the_controversi.html
http://nebraska.statepaper.com/vnews/display.v/ART/2006/01/11/43c5201525d10
Circumcision Advocates and Critics
http://www.circumcision.org/advocates.htm
Circumcision, AIDS and STDs
Anonymous. Male circumcision as a prevention method?AIDS Alert
Atlanta:Sep 2005. Vol. 20, Iss. 9, p. 101-102.
Glenn, David. “Battle Over the Knife.” The Chronicle
of Higher Education. Washington: May 27, 2005. Vol. 51, Iss.
38, p. A12-A15.
Defense Mechanism: Circumcision averts some HIV infections http://sciencenews.org/articles/20051029/fob1.asp
Ethics and Human Rights Issues
Convention on the Rights of the Child. U.N. General Assembly
Document A/RES/44/25 12 December 1989. http://www.cirp.org/library/ethics/UN-convention/
Denniston, G., "Circumcision and the Code of Ethics," Humane
Health Care International 12 (1996): 72-74.
Denniston, G. C., F. M. Hodges, and M. F. Milos, eds. Male and
Female Circumcision: Medical, Ethical, and Legal Issues in Pediatric
Practice. Kluwer Academic/Plenum Press, 1999.
Fox,
M. and M Thomson. “A covenant with the status quo?
Male circumcision and the new BMA guidance to doctors.” School
of Law, Keele University, Staffordshire, UK. http://jme.bmjjournals.com/cgi/content/full/31/8/463
Gershuni, Zachary. The Ethics of Non-Therapeutic, Neonatal Male
Circumcision. http://www.doctorsopposingcircumcision.org/essay_contest/finalists/FIRSTPLACE_GERSHUNl.doc
Milos,
Marilyn Fayre, RN, and Donna Macris, CNM, MSN. “Circumcision:
A Medical or a Human Rights Issue?” Journal
of Nurse-Midwifery, Volume 37, Number 2 (Suppl.): Pages
87S-96S,March/April 1992. http://www.cirp.org/library/ethics/milos-macris/n
Circumcision
as an Adult
Fink, K., Carson, C., DeVellis, R., "Adult Circumcision
Outcomes Study: Effect on Erectile Function, Penile Sensitivity,
Sexual Activity and Satisfaction," J Urol 167 (2002):
2113-2116.
Videos
on Circumcision
http://www.circumcisionvideos.com/
Statements of Medical Associations
http://www.cirp.org/library/statements/
AMERICAN ACADEMY OF FAMILY PHYSICIANS, Leawood, Kansas, February
14, 2002. AAFP Clinical Recommendations. Position Paper on Neonatal
Circumcision. http://www.nocirc.org/position/aafp2002.php
American Academy of Pediatrics, American College of Obstetricians
and Gynecologists. Guidelines for Perinatal Care,
Fifth Edition, November 2002.
Care of the Uncircumcised Penis
Paskey,
Janice. “A Penis primer.” Today’s
Parent. Toronto: May 2005. Vol. 22, Iss. 4, p. 116,118,120
(3 pp.)
Circumcision: A Guide for Expectant Parents
http://www.circinfo.org/parents.html
Response to American Academy of Pediatrics (AAP) Circumcision
Policy Statement
http://www.circumcision.org/aap.htm
Description of the Foreskin and its Functions
Cold, C. and Taylor, J., "The Prepuce," BJU 83 (1999):
suppl. 1: 34–44.
Gairdner D. Fate of the foreskin. Br Med J 1949: 2: 1433.
Taylor, J. et al., "The Prepuce: Specialized Mucosa of the
Penis and Its Loss to Circumcision," BJU 77 (1996): 291–295.
Resources for Jews
Brit Shalom Providers List http://www.circumstitions.com/Jewish-shalom.html
http://www.jewishcircumcision.org/spectator.htm
Female Genital Mutilation Information
http://uk.oneworld.net/external/?url=http%3A%2F%2Fipsnews.net%2Fnews.asp%3Fidnews%3D31233
Center For Disease Control Statistics
http://www.cdc.gov/
Complications of Circumcision Procedure
http://www.medic8.com/healthguide/articles/circumcision.html
Epidemic Methicillin-Resistant Staphylococcus Aureus:Dramatically Increased
Risk for Circumcised Newborn Boys Seattle: Doctors Opposing Circumcision, 2005.
Painful and Traumatic Effects of Circumcision
Anand, K. and Hickey, P., "Pain and Its Effects in the Human Neonate and
Fetus," New England Journal of Medicine 317 (1987): 1326.
Laibow, R., "Circumcision and Its Relationship to Attachment Impairment," In Syllabus
of Abstracts, Second International Symposium on Circumcision, April
30-May 3, 1991, San Francisco, 14.
Lander, J. et al., "Comparison of Ring Block, Dorsal Penile Nerve Block,
and Topical Anesthesia for Neonatal Circumcision," JAMA 278 (1997): 2157–2162.
Leboyer F. Birth without violence. New York: Knopf, 1976.
Rhinehart, J., "Neonatal Circumcision Revisited," Transactional Analysis
Journal 29 (1999): 215-221
Schoen, E. et al., "Report of the Task Force on Circumcision," Pediatrics 84
(1989): 389.
Taddio, A. et al., "Effect of Neonatal Circumcision on Pain Response during
Subsequent Routine Vaccination," The Lancet 349 (1997): 599–603.
Information on Uncircumcising
http://www.cirp.org/pages/restore.html
NFO Fun for the Family Editor Tara Bzdok is a freelance writer, antique book
dealer and single mother with a passion for natural living. She has a degree
in English literature and will begin working on her master's degree in human
nutrition in the fall of 2006.
