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
Blogs on Circumcision
Circumcision Advocates and Critics
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
Statements of Medical Associations
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
Response to American Academy of Pediatrics (AAP) Circumcision Policy Statement
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
Female Genital Mutilation Information
Center For Disease Control Statistics
Complications of Circumcision Procedure
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
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.