Circumcision- Yes or No?

bananaIf you have already circumcised your newborn son, don’t feel bad about that decision as it’s done and you made the best decision you could at the time.  If you still have that decision to make, read on.

Most of the world does not circumcise routinely and looks at this US procedure as an attack on newborn boys.  There are still places that practice female circumcision (removal of the clitoris or clitoral hood) and most of the world views this as barbaric.

The attempt to justify circumcision as a necessary medical procedure has largely failed, although many studies continue to show a statistically reduced number of UTI’s for circumcised males.  There was a flawed study done in Africa showing less HIV transmission 1% instead of 1.5% for circumcised men, but the study design all but ensured that result since circumcised men had less time to be exposed (recovering from the circumcision) and they used HIV blood tests that may take 3 months to become positive.

In the 2013 article, “Circumcision and lifetime risk of urinary tract infection: a systematic review and meta-analysis,” (which you can read here… ) this meta-analysis of 22 studies showed lack of circumcision resulted in a 23% life-time chance of a UTI and then goes on to say that complications of circumcision are only 1.5% thus concluding, “circumcision as a desirable preventive health intervention in infant males.”

I have 5 boys, all uncircumcised and now ages 18-28 and not one ever having a UTI. In a busy pediatric practice spanning 25 years, I can count on one hand the number of male UTI’s (circumcised or not) in boys who were otherwise normal. Girls, of course, have a much higher risk for UTI’s and I have seen easily hundreds of UTI’s over the years in girls. It would seem to me that it is study design, and the population that is studied, that leads to the results being published showing circumcision is protective.  I would counter that it is simply unnecessary based on the world experience and my own large practice experience.

Most importantly I feel is the issue of consent and ethics around this issue.  I have chosen not to do circumcisions in my practice and during my career.  It just feels like a cosmetic procedure with questionable benefits and very concerning ethics. As a parent I would be making the decision to remove part of my child anatomy without their ability to weigh in on the matter.  It is for that reason that many parents wait on ear piercing, to let the child decide.  With the foreskin, once gone, it is gone!  In ethics we should consider:

 

  • Is the procedure necessary/beneficial?
  • Does it avoid harm/suffering?
  • Would we choose this for ourselves?
  • Is the patient being treated as a separate person or as a member of a community? Can it wait for patient assent?
  • Is the risk and pain worth the gain? (read more here… )

 

I would say that on most counts, circumcision fails the ethics test. With the added toxic stress our newborns are experiencing in today’s world, it now seems prudent to do all we can to reduce stress.  If you have cared for a circumcised newborn you know that most cry at each diaper change in fear, and that goes on for days.  They spend the first few days of their lives repeatedly traumatized. What this does to a developing brain, and emotional health is simply not known.

The blog, “The Foreskin: Why Is It Such A Secret In North America?,” (which you can read here… ) is an interesting read providing history and world prospective on this procedure.

 

Dr. Paul

 

 

 

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