Circumcision: The Unkindest Cut

CIRCUMCISION:  THE UNKINDEST CUT


If your baby is a boy, you will be asked if you want him
circumcised--the flap of skin at the end of the penis removed. 
The act of asking this question of a parent implies that the
procedure is, to a certain extent, desirable.  I believe that
routine circumcision of the newborn is, as Shakespeare said in
another context, the "unkindest cut of all."  It is not only
unkind, but painful, unnecessary, and dangerous.

About eight years ago the American Academy of Pediatrics and the
American College of Obstetrics published statements saying that
routine neonatal circumcision is unnecessary and that the risks
outweigh the benefits, but obstetricians and the general public
have largely ignored these statements.  Studies have shown that
educating parents about the risks of circumcision has little
effect on their behavior, and the majority still have their boys
circumcised.  The reasons for doing so are vague:  "Everybody
does it," "It's cleaner," or "I thought it was necessary" are the
usual parental responses.  In a study at the University of Utah,
pediatrician Dr. Lucy Osborne asked parents why they had their
baby boys circumcised, and 14 percent of them had no reason! 
Obviously, ritual circumcision--for example, the Jewish
ceremonial bris--is a different issue.  The choice of having it
done is religious, and the arguments for and against are largely
nonmedical.

Circumcision is the most commonly performed surgical procedure in
the United States; while 85 to 90 percent of American males are
circumcised, 85 to 90 percent of males in the rest of the world
are not.  There's an old saying:  "Fifty million Frenchmen can't
be wrong."  If we're doing something the rest of the world isn't
doing, we must examine whether there's a good reason for us to
continue the practice.

In the Victorian era, routine neonatal circumcision was popular
because it was thought that circumcising the newborn would
prevent "hypersexuality" later and would keep children from
masturbating (then considered an unhealthy practice).  In
addition, it was believed that circumcision could alleviate or
prevent illnesses ranging from rheumatism to indigestion.  Of
course, this is nonsense.

In that era, the practice of circumcision increased throughout
the world and then gradually declined over the next fifty years
everywhere except the United States.  By the 1980s, the procedure
is hardly performed in Europe at all, although it's just as
commonplace here as it ever was.

Parents may think that if their son is not circumcised, he will
seem an outsider later, particularly in the locker room.  While
it's true that most boys are circumcised, it is important to
understand that the boy who is not circumcised is as normal as
the other boys who have been altered.  In a similar vein, some
people believe that if a father is circumcised, his son should
be, too.  In his book Circumcision, A Health Fallacy, Edward
Wallerstein, an advocate of leaving male anatomy alone, tells of
a circumcised father with an uncircumcised son.  At around age
three, the child asked his father about the difference between
them.  The father told the son, "When I was a baby, they thought
it was a good idea to cut off that part of the penis."

The son thought for a minute and then said, "That was sure dumb,"
and that was the end of it.

The myth that circumcision reduces the risk of cancer of the
penis in the male and cancer of the cervix in the female is
untrue.  There is no evidence that uncircumcised men contract
penile cancer more frequently than circumcised men.  Jewish women
whose husbands are circumcised have a lower rate of cervical
cancer than non-Jewish women who husbands are not circumcised, so
people came to believe that circumcision prevented cancer of the
cervix.  But in recent years we've discovered that there are
genetic predispositions to certain forms of cancer.  The fact
that Jewish males are circumcised does not account for the low
rate of cervical cancer.  It's just that Jewish women are less
genetically inclined to develop cervical cancer.  Conversely,
there is a rise in cervical cancer among teenaged girls who are
sexually active, and most of their partners are circumcised.

Another fallacy is that the man who has been circumcised has more
sexual "staying power," can remain erect longer and has greater
sexual prowess.  Totally false.  In fact, premature ejaculation
is the most common complaint of men seeking treatment for sexual
dysfunction, and most of them are circumcised.

There is also the assumption that a circumcised penis is cleaner. 
There is a secretion under the foreskin called smegma, which is
normal and similar to mucus.  It's true that boys without
foreskins don't have these secretions, but that doesn't mean that
the foreskin is unclean.  It was once believed that uncircumcised
males were more susceptible to venereal disease, that germs could
collect underneath the foreskin.  There's no evidence that
circumcision lessens that risk of venereal disease.

The only advice necessary for taking care of the foreskin is to
wash it with the same attention to hygiene given to any other
part of the body.  There's nothing scary or complicated about the
uncircumcised penis.  As Dr. Alex Comfort said, "Wash, don't
amputate."  I've heard of many boys who were circumcised because
a poorly informed doctor thought that the foreskin was too tight
when it couldn't be pulled back.  Foreskins don't retract in
babies; that's just the way they're made.  Only after three to
five years can they be pulled back even halfway.

The foreskin was put there for a purpose.  It protects the
opening at the end of the penis, the meatus, through which males
urinate.  Boys who no longer have this protection often develop
ulcers around the meatus, which can lead to later narrowing of
the opening and problems with urination.

Another argument has it that if your son is not circumcised at
birth, he may need the operation later.  The rate of neonatal
circumcision in Finland is almost zero, and the rate among older
men is about 6 in 100,000.  In other words, the chances are very
small that adult circumcision will be necessary; and even if it
is, adults are better able to tolerate complications such as
infection and bleeding than are newborns.

Two to four percent of circumcised males develop infections, and
while most of these are minor and of little concern, some can be
serious.  That makes sense, since the fresh wound is immediately
enclosed in a diaper into which the infant urinates and
defecates, not the best environment for clean wound healing. 
Normal infants can bleed from the circumcision site, and babies
with unsuspected bleeding disorders can develop a serious
problem.

Some people think that circumcision doesn't hurt.  Anyone who has
been present when a clamp was placed on a newborn's foreskin can
never again doubt that the procedure hurts.  An infant who's just
gone through the stress of birth should emerge into a world
that's loving and tender.  Why should we immediately attack his
most precious possession?

One day I attended, with one of my obstetrical colleagues, a
natural birth with soft lights, a quiet room, a Leboyer bath, all
things kind and gentle.  A few minutes later the obstetrician
came into the nursery to circumcise another newborn.  This baby
boy was lying on a table tied to a little board with his penis
poking through a sterile drape.

As the doctor was getting ready to apply the clamp, I asked, "How
can you do this after that lovely, warm delivery?"

His reply was "Don't ask."

A strange thing about circumcision is this:  for any other
operation, the surgeon who performs the procedure would follow
the patient's progress in the hospital and take care of any later
complications.  Circumcision is traditionally performed by
obstetricians, who almost never see the patient again. 
Pediatricians see the complications and deal with the problems,
and therefore, most obstetricians think that circumcision is a
benign uncomplicated procedure and don't inform parents about the
negative aspects.

Any surgical procedure should be undertaken only after "informed
consent," which means that the patient or the patient's guardian
is fully aware of the benefits and the risks--and the benefits,
of course, should outweigh the risks.

The natural-childbirth movement and the humanization of birth
practices arose when public awareness and pressure met with the
cooperation of the medical community.  Since the medical
establishment has been remiss, I hope someday a public action
group will effectively discourage circumcision.
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Excerpt from:
Off To A Great Start:  How To Relax and Enjoy Your Baby
by Loraine Stern, M.D. and Kathleen Mackay
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