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Opinions

Are There Merits In Circumcision?

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People get really heated over this issue, so let me make it clear that this is my personal opinion based on what I have researched. You may feel differently because of your religious and/or social values and I do not think you are evil for doing this to your son, but I still think you are misguided.

Circumcision is an unnecessary and permanent decision the parent makes for the child. There is no medical need for a healthy infant to have it done and once done it cannot truly be undone. This is a cosmetic surgery, at best, and done to newborn boys who are stuck with this decision for the rest of his life. I present to you the following reasons people have to circumcise a child:

  1. To follow a social (locker room fear), cultural (this runs in the family and/or is common in the community) or religious expectation.
  2. To prevent urinary tract infections.
  3. To prevent penile cancer.
  4. To prevent stds.
  5. To make the area easier to clean.

On the surface, these would seem like good reasons to circumcise a child. Besides, one may argue, this procedure is a minor surgery with a rare chance of complication resulting from the pain medication, heavy bleeding, or a bad cut. Men and boys who were circumcised have no memory of the operation and it does not really haunt them. Besides, it makes it easier to keep clean and saves the parent from explaining to the boy how to clean "under the hood".

If that were all I had to go on I would have been in a rush to make sure that when my son was born he was first in line to get the cut. However, I did do the research before his birth and all the reasons people had to cut were with merit, there were other reasons to consider not getting it done based on the same logic.


Issue 1 - Social/Cultural/Religious Reasons

To do things just because that's the way they have always been is not a good excuse to do something. Slavery has also gone on for a long time, but that does not make it right. Routine spouse and child abuse have gone on for ages as the right of the head of the house, and still that is not right. Female circumcision is practiced in some countries as a tradition, and even if this is obviously a lot more cruel to those of us in the Western world than male circumcision [and nowhere close to being the same thing], it is viewed as a necessary thing to protect the purity of the daughter.

Jews and Muslims do this as part of a religious requirement. God told them to do it and I cannot compete with that order. If you have deep religious convictions about this procedure and you live in a country where you are free to follow your conscience, there really isn't much I could say to convince you otherwise if you truly believe that is the best for your son. Things done in the name of religion do not mean it is right, but that is up to you to face.

In the US, circumcision was not really done until around the Victorian era when things of a sexual nature were viewed with repulsion. It was thought circumcision would keep the child from masturbation. Thus many Protestant families did this routinely to their sons and it became the society norm.

Today, the rate of boys not being circumcised in the US is getting closer to 50/50, so the issue of locker room embarrassment is not a valid one. There are more in camp that are not cut.


Issue 2 - To Prevent Urinary Tract Infections

Urinary tract infections are caused by bacteria and are more common among women than men. What causes it? Some risk factors include the following:

A new sex partner or multiple partners
More frequent or intense intercourse
Diabetes
Pregnancy
Use of irritating products such as harsh skin cleansers
Use of irritating contraceptives such as diaphragms and spermicides
Use of birth control pills
Heavy use of antibiotics
A blockage in the urinary tract (benign masses or tumors)
A history of UTIs, especially if the infections were less than six months apart

This is where I had a field day with the research. To all you who doubt the sources, I leave you these quotes along with the citations of where you will find them:


BOLETINO MEDICO INFANTE MEXICANO, Volume 49, Number 10, Pages 652-658, October 1992.

CIRCUMCISION OF THE NEWBORN MALE AND THE RISK OF URINARY TRACT INFECTION DURING THE FIRST YEAR: A META-ANALYSIS

INTRODUCTION

In 1975 the Ad Hoc Task Force on Circumcision stated that "There is no absolute medical indication for routine circumcision in the newborn period".1 In 1983 The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists in their joint publication Guidelines to Perinatal Care supported this viewpoint.2 Nevertheless, circumcision continued to be done on the large majority of infants in the United States of America after the above statements were published3. It seems though in the recent years that the frequency of this procedure has somewhat diminished.


From BUPA. BUPA is a global health and care organisation, with members in nearly 190 countries worldwide.

What causes a urinary tract infection and who is at risk? The bacteria that cause UTI are usually the individual's own normal intestinal organisms which, in certain circumstances, are able to pass from the area around the anus into the urethra (the tube connecting the bladder with the outside of the body) and so into the bladder. Nephritis is usually caused by the same kinds of bacteria managing to spread from the bladder into the ureters (the tubes connecting the kidneys to the bladder) and up to the kidneys. UTI can also be caused by other bacteria, including tuberculosis, reaching the kidneys via the bloodstream.

A number of factors increase the risk of developing UTI:

Being female: the female urethra is shorter than the male's, and this, together with the antibacterial actions of some secretions of the male's prostate gland, probably accounts for why women are more likely than men to develop UTI.
Sexual position: Some women find that they are liable to develop a UTI if, during sexual intercourse, their partner enters their vagina from behind. This is simply because in this position it is more likely that bacteria from around the anus may be pushed forward towards the urethra
Failure to completely empty the bladder: The most important causes of this are obstruction caused by prostate enlargement in men or neurological diseases in either sex
Abnormal structure of the bladder: This can be something that you are born with or that develops later in life
'Vesico-ureteric reflux': This is a condition that some children are born with, in which urine flows back into the ureters or kidney during urination
Being pregnant
Being diabetic
A tumour in the urinary tract
Stones in the urinary tract
'Foreign body' in the urinary tract: Urinary catheters, nephrostomy tubes (a tube inserted into the kidney to drain urine to the abdominal surface) and ureteric stents (a wire tube fitted in the urethra to keep the passage open) all tend to increase the likelihood of infection.

THE LANCET, Volume 352, Number 9143, 5 December 1998. Cohort study on circumcision of newborn boys and subsequent risk of urinary-tract infection

Background A decrease in risk of urinary-tract infection is one of the most commonly given reasons for circumcision of newborn boys. Previous studies have reported rates of UTI to be 10-20 times higher in uncircumcised than in circumcised boys. This population-based cohort study followed neonates in Ontario, Canada, prospectively to study the relation between circumcision and subsequent UTI risk.

Methods Eligible boys were born to residents of Ontario between April 1, 1993, and March 31, 1994. We used hospital discharge data to follow up boys until March 31, 1996.

Findings Of 69,100 eligible boys, 30,105 (43.6%) were circumcised and 38,995 (56.4%) uncircumcised. 888 boys circumcised after the first month of life were excluded. 29,217 uncircumcised boys were matched to the remaining circumcised boys by date of birth. The 1-year probabilities of hospital admission for UTI were 1.88 per 1000 person-years of observation (83 cases up to end of follow-up) in the circumcised cohort and 7.02 per 1000 person-years (247 cases up to end of follow-up) in the uncircumcised cohort (p 0.0001). The estimated relative risk of admission for UTI by first-year follow-up indicated a significantly higher risk for uncircumcised boys than for circumcised boys (3.7 [2.8-4.9]). 195 circumcisions would be needed to prevent one hospital admission for UTI in the first year of life.

Interpretation Although our findings support the notion that circumcision may protect boys from UTI, the magnitude of this effect may be less than previously estimated.

Lancet 1998; 352: 1813-16.


Issue 3 - To Prevent Penile Cancer

Again, I point to facts that can be found around the web for your further investigation.


Penile Cancer Myths
Journal of the American Medical Association, Volume 213 Number 11: Pages 1853-1858.
September 14, 1970.
Whither the Foreskin?
A Consideration of Routine Neonatal Circumcision
By CAPT E. Noel Preston, MC, USAF

Preston established quite clearly that there was little evidence to support a relationship between lack of circumcision and penile cancer, cervical cancer, or cancer of the prostate in 1970 but he was unable to identify the causative agent at that time.


Wolbarst's hypothesis about smegma and cancer found its way into early medical textbooks. In the 1950s a few experiments were done to test the hypothesis by injecting horse smegma into wounds made in the backs of mice. There were clinical studies that attempted to induce cancer by introducing smegma subcutaneously and intravaginally: No carcinomas could be induced.

The smegma hypothesis was finally disproven by an exhaustive study by Reddy2 in 1963. His results were: "The conviction that human smegma is a carcinogen could not be substantiated."

D.G. Reddy; I.K. Baruah. "Carcinogenic Action of Human Smegma," Archives of Pathology, vol. 75, no. 4 (April 1963): pp. 414-420.


AMERICAN CANCER SOCIETY NATIONAL HOME OFFICE
February 16, 1996
Dr. Peter Rappo
Committee on Practice & Ambulatory Medicine
American Academy of Pediatrics
141 Northwest Point Boulevard
P. O. Box 927
Elk Grove Village, IL 60009-0927

Dear Dr. Rappo:

As representatives of the American Cancer Society, we would like to discourage the American Academy of Pediatrics from promoting routine circumcision as preventative measure for penile or cervical cancer. The American Cancer Society does not consider routine circumcision to be a valid or effective measure to prevent such cancers.

Research suggesting a pattern in the circumcision status of partners of women with cervical cancer is methodologically flawed, outdated and has not been taken seriously in the medical community for decades.

Likewise, research claiming a relationship between circumcision and penile cancer is inconclusive. Penile cancer is an extremely rare condition, effecting one in 200,000 men in the United States. Penile cancer rates in countries which do not practice circumcision are lower than those found in the United States. Fatalities caused by circumcision accidents may approximate the mortality rate from penile cancer.

Portraying routine circumcision as an effective means of prevention distracts the public from the task of avoiding the behaviors proven to contribute to penile and cervical cancer: especially cigarette smoking and unprotected sexual relations with multiple partners. Perpetuating the mistaken belief that circumcision prevents cancer is inappropriate.

Sincerely,

Hugh Shingleton, M.D. Clark W. Heath, Jr., M.D.
National Vice President Vice President
Detection & Treatment Epidemiology & Surveillance Research

From The American Cancer Society Web Site

Circumcision: Whether or not circumcision is a negative risk factor (if it protects against penile cancer) is a very controversial issue.

Circumcision is the removal of a part or all of the foreskin at birth or later on in life. This practice has been suggested as conferring some protection against cancer of the penis by contributing to improved hygiene. However, the penile cancer risk is low in some uncircumcised populations, and the practice of circumcision is strongly associated with socio-ethnic factors which in turn are associated with lessened risk. The consensus among studies that have taken these other factors into account is that circumcision is not of value in preventing cancer of the penis. It is important that the issue of circumcision not distract the public's attention from avoiding known penile cancer risk factors -- having unprotected sexual relations with multiple partners (increasing the likelihood of human papillomavirus infection) and cigarette smoking.


BRITISH MEDICAL JOURNAL, (London) Vol. 312 no 7033 (March 23, 1996): pp. 779-780

NEONATAL CIRCUMCISION DOES NOT PROTECT AGAINST CANCER

All subsequent repetions of this myth are traceable to Wolbarst's article, though Wolbarst himself advocated universal neonatal circumcision principally as a preventive for epilepsy, paralysis, and masturbation. Circumcisionists such as Wolbarst do not seem to have promoted this myth because they have a genuine interest in reducing penile cancer; they used it instead as a scare tactic to increase the rate of neonatal circumcision. It is surprising that sober scientists such as Frisch and colleagues could have relied on such a reference in their research.

Epidemiological studies disproved Wolbarst's myth long ago. In North America the rate of penile cancer has been estimated to be 1 in 100,0003 - somewhat higher than the rate of 0.82 per 100,000 found by Frisch and colleagues. Maden et al reported penile cancer among a fifth of elderly patients from rural areas who had been circumcised neonatally and had been born at a time when the rate of neonatal circumcision was about 20% in rural populations.4 Their study also shows that the rate of penile cancer among men circumcised neonatally has risen in the United States relative to the rise in the rate of neonatal circumcision.


Issue 4 - To Prevent STDs

The research I found shows that having an intact foreskin reduces the risk of infection, however, risky sexual behavior of any kind, circumcised or not, will lead to an std.


Genitourinary Medicine 1993, Vol. 69, Pages 262-264. Clinical Presentation of Genital Warts Among Circumcised and Uncircumcised Heterosexual Men Attending an Urban STD Clinic

Introduction - A recent study comparing heterosexual men with and without confirmed sexually transmitted diseases (STDs) in an urban STD clinic showed that uncircumcised men were less likely than circumcised men to have genital wart detectable by clinical examination (adjusted odds ratio 0.7, 95% confidence interval 0.4, 0.9). Based on these initial findings we hypothesised that the appearance and anatomic distribution of genital warts, and possibly treatment response, may be different for circumcised and uncircumcised men.

Methods - The anatomic location, appearance, number of warts, and response to treatment was investigated through review of medical records of 459 heterosexual men with genital warts detected in 1988.

Results - Age- and race-adjusted estimates indicated that among men with genital warts, warts were detected much more commonly on the distal penis - that is, the corona, frenulum, glans or urethrul meatus - among uncircumcised men (26%) than among circumcised men (3%) (OR 10.0, 95% CI 3.9, 25.7). Where the appearance was specified, warts were more often described as condylomatous in uncircumcised men and slightiy more often as papular in circumcised men. No significant difference between circumcised and uncircumcised men was seen in the number of return visits to the clinic for persistent warts after treatment with liquid nitrogen: 2.2 visits for 19 uncircumcised men and 2.3 visits for 149 circumcised men.

Conclusion - Circumcised men were more likely than uncircumcised men to have genital warts, but when present, warts were more often located on the distal portion of the penis among uncircumcised men. This paradox is not understood, but could reflect either non-specific resistance to proximal penile warts conferred by the foreskin, or heightened susceptibility to various HPV types in uncircumcised men, some of which may confer subsequent immunity to genital warts.


Issue 5 - It Helps To Keep The Area Clean

This is about the only point that seems to be unchallenged, but there are still issues with this. It is easy to just wipe the tip of a penis than to retract the foreskin to clean. The misconception comes from the idea that a male infant's foreskin retracts in the first place. It takes years before that even happens, so for all intents and purposes, the skin is so close it is almost like it is fused together. Cleaning a baby with foreskin intact is just as easy as cleaning a circumcised boy.

When a boy gets old enough to bathe by himself, then he needs to learn the correct way to clean. It really isn't that much of a big deal. If you want to wash your arm pits, you raise up your arms. If you want to wash the crack of your backside, you part the cheeks. So if you want to wash the head of a penis, you raise up the hood.

What Is The Medical Response To The Issue?


On March first 1999, The American Academy Of Pediatrics reviewed over forty years of medical literature concerning circumcision and concluded there is no reason to circumcise a newborn boy for a medical prevention.

The A.A.P. does not recommend newborn circumcision of either boys or girls.


British Journal of Sexual Medicine,
Sept/Oct 1994
THE CASE AGAINST CIRCUMCISION
J P WARREN, FRCP
Physician, Princess Alexandra Hospital, Harlow. CM20 1QX.
J BIGELOW, PhD
Psychologist, POB 52138, Pacific Grove, CA 93950

SUMMARY: The origin of circumcision as a form of ancient sacrifice is discussed. Recently described information about the structure and function of the prepuce is presented. It is suggested that the prepuce is responsible for much of the erogenous sensation in the penis. The indications for circumcision are considered. Unnecessary circumcisions are still being carried out. The methods and results of foreskin restoration in circumcised men are referred to. It is recommended that circumcision should be avoided whenever possible and that there is a need for further research into the location and function of sensory receptors in the male genitalia and the psychological effects of circumcision.


Pediatricians, Nurses, and Midwives against circumcision


Article from Men's Fitness, September 1999, pages 41-42, 130. dispells the myths about not circumcising the penis such as the misleading data that not cutting will lead to penile cancer, stds and so forth.


American Academy of Pediatrics
Press Release
NEW AAP CIRCUMCISION POLICY RELEASED
For Release: March 1, 1999, 5 p.m. (ET)

Below is a highlight of a policy published in the March issue of Pediatrics, the peer-reviewed, scientific journal of the American Academy of Pediatrics (AAP).

CHICAGO - After analysis of almost 40 years of available medical research on circumcision, the American Academy of Pediatrics (AAP) issued new recommendations today stating that the benefits are not significant enough for the AAP to recommend circumcision as a routine procedure. The new policy statement was published in this month's issue of Pediatrics, the journal of the AAP.

"Circumcision is not essential to a child's well-being at birth, even though it does have some potential medical benefits. These benefits are not compelling enough to warrant the AAP to recommend routine newborn circumcision. Instead, we encourage parents to discuss the benefits and risks of circumcision with their pediatrician, and then make an informed decision about what is in the best interest of their child," says Carole Lannon, M.D., MPH, FAAP, chair of the AAP's Task Force on Circumcision.


In conclusion, I cannot justify having a procedure done to my son which is not reversible, not medically necessary, painful, and most importantly, should be his own decision to make about his body. Unless there was a medical necessity to arise to get it done, I would never do this to my son.

I would also not force ear piercing or a tatoo on my children without their consent. Even though you can always allow the ear to heal and close over the incision and a tatoo can be lasered out with great pain, you cannot undo the damage of cutting off the foreskin without a plastic surgical procedure.

Wouldn't it be better to keep the parts you were born with and only if they present a problem then cut them off? If this is a matter of religion for you or you feel it is still not that big of a deal, you are not a monster and are doing what you think is the right thing, but I still believe it is a barbaric and archaic practice.