United States slowly losing faith in circumcision

Although routine circumcision emerged in the United States around the same time as in Britain and for much the same reasons - fear of masturbation, syphilis and "congenital phimosis" - Americans took faith in the operation to an extreme not seen in Britain. At the very time when British doctors had lost interest, Americans were just getting into their stride, and as the incidence of circumcision in Britain fell to vanishing point during the 1950s, in the USA it reached new heights, affecting about 95 per cent of boys. Circumcision became entrenched as an automatic part of the birth procedure, and was often performed without the consent even of the parents. Naturally, the large cohort of circumcised men that resulted from this policy, and so many doctors profiting from the operation, or for other reasons believing firmly in its necessity, meant that circumcision acquired the status of a traditional custom, and one that has proved very difficult to erode. It is no accident that most of the research that seems to show the value of circumcision as a prophylactic against various diseases is generated in the USA, or funded by American medical institutions.

Despite all these obstacles, the incidence of circumcision in the United States has been declining slowly since the 1970s, and more rapidly since the turn of the century: one recent estimate claims that it has fallen as low as 33 per cent, though this figure is not accepted by everybody. A feature of the US situation is the growing gulf between the official opinion of bodies such as the Centers for Disease Control and the circumcision policy committees of the American Academy of Pediatrics, on the one hand, which are stacked with believers in circumcision and wish to see the practice continue, and a growing community groundswell against the practice, led by women, and especially mothers, on the other. One expression of this movement is a proposal in California for a new law to treat medically unnecessary circumcision of a male minor on the same basis as female genital cutting, that is, as a criminal offence. Whether or not the law is passed, it is stimulating debate on the issue, and for the first time in many years the circumcision advocates find themselves in a defensive position, and rather on the back foot, as an increasing number of critical articles in mainstream newspapers and magazines suggest.

On this page

Recent articles in American press

American opposition to circumcision gathers steam

Another U.S. state drops circumcision from medical benefits schedule

US circumcision incidence falling steadily - Now a minority practice in west

Further information

History of circumcision in the United States

Intact America

Nocirc USA

Peaceful Parenting

Cutting through circumcision and foreskin myths

Further evidence that intelligent Americans are rejecting and abandoning circumcision is provided in a September issue of the on-line journal Psychology Today, which has published a series of articles tackling common myths about the foreskin and circumcision. In one of these articles Dr Darcia Narverez considers the perennial issues of hygiene, cleanliness and sexually transmitted diseases.

Is circumcision cleaner and healthier?

There's a lot of hype about how circumcision is better for a man's health. But is it really? Here is Part 2 of our series on myths about circumcision.

Myth: You have to get the baby circumcised because it is really hard to keep a baby's penis clean.

Reality check: In babies, the foreskin is completely fused to the head of the penis. You cannot and should not retract it to clean it, as this would cause the child pain, and is akin to trying to clean the inside of a baby girl's vagina. The infant foreskin is perfectly designed to protect the head of the penis and keep feces out. All you have to do is wipe the outside of the penis like a finger. It is harder to keep circumcised baby's penis clean because you have to carefully clean around the wound, make sure no feces got into the wound, and apply ointment.

Myth: Little boys won't clean under their foreskins and will get infections.

Reality check: The foreskin separates and retracts on its own sometime between age 3 and puberty. Before it retracts on its own, you wipe the outside off like a finger. After it retracts on its own, it will get clean during the boy's shower or bath. Once a boy discovers this cool, new feature of his penis, he will often retract the foreskin himself during his bath or shower, and you can encourage him to rinse it off. But he should not use soap as this upsets the natural balance and is very irritating. There is nothing special that the parents need to do. Most little boys have absolutely no problem playing with their penises in the shower or anywhere else! It was harder to teach my boys to wash their hair than it was to care for their penises. (Camille 2002)

Myth: Uncircumcised penises get smelly smegma.

Reality check: Actually, smegma is produced by the genitals of both women and men during the reproductive years. Smegma is made of sebum and skin cells and lubricates the foreskin and glans in men, and the clitoral hood and inner labia in women. It is rinsed off during normal bathing and does not cause cancer or any other health problems.

Myth: "My uncle wasn't circumcised and he kept getting infections and had to be circumcised as an adult."

Reality check: Medical advice may have promoted infection in uncircumcised males. A shocking number of doctors are uneducated about the normal development of the foreskin, and they (incorrectly) tell parents that they have to retract the baby's foreskin and wash inside it at every diaper change. Doing this tears the foreskin and the tissue (called synechia) that connects it to the head of the penis, leading to scarring and infection.

Misinformation was especially prevalent during the 1950s and 60s, when most babies were circumcised and we didn't know as much about the care of the intact penis, which is why the story is always about someone's uncle. Doing this to a baby boy would be like trying to clean the inside of a baby girl's vagina with Q-tips at every diaper change. Rather than preventing problems, such practices would cause problems by introducing harmful bacteria. Remember that humans evolved from animals, so no body part that required special care would survive evolutionary pressures. The human genitals are wonderfully self-cleaning and require no special care.

Myth: "My son was diagnosed with phimosis and so had to be circumcised."

Reality check: Phimosis means that the foreskin will not retract. Since children's foreskins are naturally not retractable, it is impossible to diagnose phimosis in a child. Any such diagnoses in infants are based on misinformation, and are often made in order to secure insurance coverage of circumcision in states in which routine infant circumcision is no longer covered. Even some adult men have foreskins that do not retract, but as long as it doesn't interfere with sexual intercourse, it is no problem at all, as urination itself cleans the inside of the foreskin (note that urine is sterile when leaving the body.)

Phimosis can also be treated conservatively with a steroid cream and gentle stretching done by the man himself, should he so desire it, or, at worst, a slit on the foreskin, rather than total circumcision. (Ashfield 2003) These treatment decisions can and should be made by the adult man.

Myth: Uncircumcised boys get more urinary tract infections (UTIs.)

Reality check: This claim is based on one study that looked at charts of babies born in one hospital (Wiswell 1985). The study had many problems, including that it didn't accurately count whether or not the babies were circumcised, whether they were premature and thus more susceptible to infection in general, whether they were breastfed (breastfeeding protects against UTIs), and if their foreskins had been forcibly retracted (which can introduce harmful bacteria and cause UTI) (Pisacane 1990). There have been many studies since which show either no decrease in UTIs with circumcision, or else an increase in UTI from circumcision. Thus circumcision is not recommended to prevent UTI (Thompson 1990). Girls have higher rates of UTI than boys, and yet when a girl gets a UTI, she is simply prescribed antibiotics. The same treatment works for boys.

Myth: Circumcision prevents HIV/AIDS.

Reality check: Three studies in Africa several years ago that claimed that circumcision prevented AIDS and that circumcision was as effective as a 60% effective vaccine (Auvert 2005, 2006). These studies had many flaws, including that they were stopped before all the results came in. There have also been several studies that show that circumcision does not prevent HIV (Connolly 2008). There are many issues at play in the spread of STDs which make it very hard to generalize results from one population to another. In Africa, where all the recent studies have been done, most HIV transmission is through male-female sex, but in the USA, it is mainly transmitted through blood exposure (like needle sharing) and male-male sex. [Circumcision has been shown to have no protective effect in these situations.] Male circumcision does not protect women from acquiring HIV, nor does it protect men who have sex with men (Wawer 2009, Jameson 2009).

What's worse, because of the publicity surrounding the African studies, men in Africa are now starting to believe that if they are circumcised, they do not need to wear condoms, which will increase the spread of HIV (Westercamp 2010). Even in the study with the most favorable effects of circumcision, the protective effect was only 60% - men would still have to wear condoms to protect themselves and their partners from HIV. In the USA, during the AIDS epidemic of the 1980s and 90s, about 85% of adult men were circumcised (much higher rates of circumcision than in Africa), and yet HIV still spread. It is important to understand, too, that the men in the African studies were adults and they volunteered for circumcision. Babies undergoing circumcision were not given the choice to decide for themselves.

Myth: Circumcision is worth it because it can save lives.

Reality check: Consider breast cancer: There is a 12% chance that a woman will get breast cancer in her lifetime. Removal of the breast buds at birth would prevent this, and yet no one would advocate doing this to a baby. It is still considered somewhat shocking when an adult woman chooses to have a prophylactic mastectomy because she has the breast cancer gene, yet this was a personal choice done based upon a higher risk of cancer. The lifetime risk of acquiring HIV is less than 2% for men, and can be lowered to near 0% through condom-wearing (Hall 2008). How, then, can we advocate prophylactic circumcision for baby boys?

Bottom line:  Science and data do not support the practice of infant circumcision. Circumcision does not preclude the use of the condom. The adult male should have the right to make the decision for himself and not have his body permanently damaged as a baby.

REFERENCES

Ashfield, J., et al., Treatment of phimosis with topical steroids in 194 children, JOURNAL OF UROLOGY, Volume 169, Number 3: Pages 1106-1108, March 2003.

Auvert, B. et al., Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial, PLoS Med. 2005 Nov;2(11):e298. Epub 2005 Oct 25.

Camille CJ, Kuo RL, Wiener JS. Caring for the uncircumcised penis: What parents (and you) need to know. Contemp Pediatr 2002;11:61.

Connolly, C. et al., Male circumcision and its relationship to HIV infection in South Africa: Results of a national survey in 2002, South African Medical Journal, October 2008, Vol. 98, No. 10.

Hall, H. et al., Estimating the lifetime risk of a diagnosis of the HIV infection in 33 states, 2005-2005; J Acquir Immune Defic Syndr. 2008;49(3):294-297.

Jameson, D. et al., The Association Between Lack of Circumcision and HIV, HSV-2, and Other Sexually Transmitted Infections Among Men Who Have Sex With Men, Sex Transm Dis. 2009 Nov 6.

Pisacane A, et al. Breastfeeding and urinary tract infection. The Lancet, July 7, 1990:50.

Thompson RS: Does circumcision prevent urinary tract infection? An opposing view. J Fam Pract 1990; 31: 189-96.

Wawer, M. et al., Circumcision in HIV-infected men and its effect on HIV transmission to female partners in Rakai, Uganda: a randomised controlled trial, The Lancet, Volume 374, Issue 9685, Pages 229 - 237, 18 July 2009.

Westercamp, W., et al., Male Circumcision in the General Population of Kisumu, Kenya: Beliefs about Protection, Risk Behaviors, HIV, and STIs, PLoS ONE 5(12): e15552. doi:10.1371/journal.pone.0015552

Wiswell TE, Smith FR, Bass JW. Decreased incidence of urinary tract infections in circumcised male infants. Pediatrics 1985, 75: 901-903.

Source: Darcia Narvaez, Ph.D, Circumcision myths you may believe: Hygiene and sexually transmitted diseases (STDs), Psychology Today, 13 September 2011. Darcia Narvaez is an Associate Professor of Psychology and Director of the Collaborative for Ethical Education at the University of Notre Dame, USA.

Recent articles in the American press

San Francisco bill will protect newborns, allow men the freedom to choose

by Claire Vriezen

Iowa State Daily, 2 March 2011

I must begin with acknowledging that by nature of being female, I am not as qualified as some to be addressing this issue. But as a human being, concerned with human rights, I am indeed allowed to comment. Citizens of San Francisco are working to pass a bill that would outlaw male circumcision until the child reaches the age of 18. The bill would allow for exceptions if the procedure was deemed medically relevant, and the person performing the circumcision must be a medical practitioner where the procedure is performed. No exceptions will be made for those that desire their child to undergo the operation as a matter of custom or tradition.

Although circumcision rates among male newborns has decreased in the past few years, 32 percent of male infants are still having bits of their anatomy snipped off after leaving the womb. It baffles me how widely accepted this practice still is, despite it’s similarity to female genital mutilation. In both cases, young children or newborns are subjected to a procedure that removes part of their sexual anatomy — half the time without anesthetic — because their parents judge it to be acceptable.

But isn’t it the job of the parents to know what is good for their children? Sure, for the most part. But when decisions result in the surgical removal of a normal, healthy part of anatomy, rationale must be called into question. There’s a reason the American Medical Association, as well as most of the medical community, term male circumcision as “non-therapeutic.” In many other developed countries — Canada, the Netherlands and other European countries — medical societies strongly recommend against routine circumcision of males. There is no immediate reason for the majority of male newborns to be circumcised.

The main medically based argument for circumcision seems to be that it reduces the risks of sexually transmitted diseases and infections. Most commonly cited are studies that provide a positive correlation between higher HIV rates and lack of circumcision. The World Health Organization has decided the relevant research is compelling enough to recognize male circumcision as a way to reduce the risk of HIV infection, though others claim the studies conducted have exaggerated data and overlooked confounding factors.

Regardless, this still does not provide a basis for circumcising infants. Is an infant expected to participate in sexual behaviors that could result in HIV exposure? I should hope not. Is circumcision the only way to reduce HIV risks? No. Condoms remain an effective way to combat HIV exposure and safe-sex education and practices are much preferred options when seeking to reduce STI rates.

Perhaps an even more common defense of circumcision is the claim that it is a cultural or religious decision of the parents. This defense has even less basis than medically related evidence. To again make the comparison, female genital mutilation is a common cultural or religious practice in many African, Middle Eastern and Asian regions. Yet, we regard this act with disgust, and we pity the young girls forced to endure it. Research on female genital mutilation has even resulted in some reports linking it to lower HIV rates, but this does nothing to quell our horror. Certain cultural practices that result in the genital mutilation of an infant — male or female — should most certainly be subject to scrutiny.

But what about those that desire to circumcise their child for religious reasons? The most obvious example is Judaism. Circumcision is required by Jewish law, so shouldn’t children born into Jewish families be circumcised? Freedom of religion allows people to practice what they want, right? This is true, up until the point where religion crosses ethical lines. There have been court cases where the medical needs of the child violated the religious beliefs of the parents, and the courts tend to rule that the life and health of the child overrides the religious dictates of the parents. Religious circumcisions should follow the same guidelines. In this case, medically irrelevant amputation of the foreskin on an infant crosses similar ethical boundaries. If treating a child for disease overrides the religion of the parents, shouldn’t preserving the child’s anatomy fall under the same protection?

I do not know whether the bill put forth in San Francisco will amount to anything, but I hope the decline of circumcision among newborn males continues. Infants need not be subjected to an undoubtedly painful procedure with dubious medical benefits. With only a third of the world’s male population circumcised, a good deal of men seem to be getting along just fine without the procedure.

To promote male circumcision is to promote the marring of a normal body and to promote needless pain for newborns. If young men reach 18 and find they are willing to undergo the operation and become circumcised for whatever reason they choose, that is their prerogative. Whether they deem the alleged benefits valid or whether they have religious, cultural, or personal motivations, it should be their own decision to remove a part of their body, and no one else’s.

Full text with comments

 

Circumcision, genital mutilation must end

by Ryan Holland
The Daily Targum, 8 March 2011

Male circumcision is a deplorable act with an archaic founding and should not be allowed to continue. Jews believe in circumcision because of God's discussion with Abraham in Genesis. Abraham — who by the way was 100-years-old at the time — was told that any uncircumcised child will have his soul "cut off from his people" (Genesis 17:14). Similarly, Passage 16:123 in the Quran states that Allah wanted the Prophet Muhammad to live according to Ibrahim's faith. Noting that Ibrahim circumcised himself — with an axe, by the way — the prophet decided to continue the tradition. The fact that Jews, Muslims and followers of other religions believe in circumcision does not mean that it should be accepted. Some pious followers believe that AIDS was created to punished homosexuals or that women who have extramarital sex should be stoned to death. Just because these beliefs come from a religious background does not mean that they should be tolerated. Religion is a poor excuse for genital mutilation.

It is not a hyperbole to describe circumcision as genital mutilation. The majority of men in this world and virtually all of male animals are uncircumcised. It does not appear as if they are any less healthy because of this. There is also arguably very little benefit to cutting off one's foreskin, and it is agreed upon by the medical community that there is no medical need to have one. Conversely, there are various downsides to the practice. For one, infections and even death can occur because of this unnecessary surgery. Hundreds of babies die every year because of complications related to circumcision. Furthermore, there is a noticeable sexual numbness that those with less foreskin experience. After circumcision, the glans become less sensitive, which impedes pleasure. Also, uncircumcised men declare that most of their sexual excitement comes from the foreskin — not the glans. By removing the foreskin along with all of its nerves, there is a significant decrease in the sexual experience.

Many argue that the government should not be able to interfere with religious practices. That is a ridiculous generalization to make. Surely, it is okay for the United States to ban female circumcision or lashings for public intoxication even though these acts are based on religious doctrines. It is our responsibility as human beings to bring attention to great injustices. The act of circumcision for religious purposes is a very thinly veiled excuse to mutilate a baby's genitals. There is no medical need to have a circumcision, and it can in fact cause harm and even death. It also causes irreversible sexual damage. It is inexcusable to let this practice continue. What others think their god believes is meaningless when it comes to human rights violations. Circumcision and other forms of genital mutilation need to end. Thinking otherwise is disgraceful to our species.

Ryan Holland is a School of Arts and Sciences sophomore majoring in cell biology and neuroscience at Rutgers University.

Full text with comments

American opposition to infant circumcision gathers steam

A few months ago the proposal for a citizens’ ballot to place a legal prohibition on circumcision of male minors was regarded as yet another silly Californian whim that would get nowhere, but the success of the promoters in gathering sufficient signatures to put the proposal to a referendum has alarmed devotees of circumcision and aroused fierce editorials and mockery in the mainstream media - and of course the familiar accusation that the measure is motivated by anti-semitism. Conservatives now fear that the referendum may actually be passed, and are pulling out all stops in an effort to discredit the promoters.

Despite the hostile media blitz, accusations of anti-semitism are difficult sustain when the proposal is aimed principally at the 50 per cent (approx) of American parents who circumcise their sons, 97 per cent of whom are not Jewish at all, and when it is supported by numerous Jewish men and women and has actually been given sympathetic coverage in quite conservative Jewish media, such as the Jewish Reporter. A recent edition carried a forceful article by Rebecca Wald (founder of the website Beyond the Bris) in favour of the measure, which attracted an immense volume of comment (some hostile, much supportive) on the journal’s website.

Another Jewish mother recently published a heartfelt critique of circumcision on the parenting forum Babble.com, explaining why she, as a Jewish woman, had decided that it was morally wrong to circumcise her sons: "Despite a [Jewish] cultural legacy of thousands of years, my husband and I did not circumcise our son ... Let’s keep American baby boys intact. It’s wrong to force an irreversible circumcision on a child when he is too young to decide for himself."

Conservative Jewish site publishes op-ed praising circumcision ban measure.


Questioning circumcision
by REBECCA WALD

The prospect of a circumcision ban sits poorly with many in America where parents enjoy relatively broad rights to raise their children as they choose. Jewish people are understandably concerned, fearing such restrictions would be discriminatory, hurtful, and violate religious freedom. However, as a Jewish person who opposes the genital cutting of all children absent medical necessity, I’m glad these measures are being considered. What’s best for children deserves continual assessment and, thanks to these proposals, that’s happening.

My husband and I are both Jewish. We’re both American. Yet deciding to leave our son with the penis he was born with was not difficult. Causing pain to our beautiful child and forever changing his body didn’t seem right. We considered infant circumcision from different angles and concluded the surgery wasn’t in his best interest, either as a tender newborn or as the man he will become.

In December I launched Beyond the Bris, a web-based project that is putting real faces and voices to the Jewish movement against infant circumcision. It is an open and dynamic forum where likeminded Jewish people can come together. We share our ideas with one another and visitors to the project in whatever ways feel right to us. This includes original music, poetry and art. I couldn’t be happier with the terrific response I’ve been getting from Jews in America, Israel and elsewhere who agree that children are entitled to keep their whole sex organs.

Skim the recent headlines and you will likely read stories of Jewish outrage over the proposed circumcision bans in California. However this isn’t the full story. I recently spoke with Lloyd Schofield, the San Franciscan who spearheaded the effort to place the ban on the November ballot. He expressed to me his amazement about how open, interested and positive many members of the Jewish community have been about his efforts. He told me that when he was gathering signatures, many people self-identified as Jews and some signed his petition on the spot. Others declined, but even within this group he said all were respectful and many seemed genuinely happy to take educational handbills and learn more about the subject.

I think the positive Jewish response to the Beyond the Bris project and to the efforts in California speaks tremendously of the Jewish people; that we are willing to seriously consider this issue even when it means challenging thousands of years of tradition. I can’t say I’m surprised. Jewish people have been integral in every rights movement in this country and this is no exception. Parents agreeing to cut their children’s healthy sex organs has occurred throughout history among diverse cultures. Groups that cut rationalize their behavior yet are quick to criticize other groups who modify the sex organs differently.

I would encourage anyone who thinks along these lines to look into the anatomy of the natural versus the circumcised penis and what foreskin removal really is and does from an anatomical perspective. FGC is done for many of the same reasons as male infant circumcision including perceived cleanliness, preferred appearance, cultural and religious tradition and the prevention of disease. In recent years, FGC has even moved to modern hospitals, for those families who can afford it, and is performed by trained physicians. Medical studies have even “proved” FGC prevents sexually transmitted disease.

It’s difficult to step outside of one’s culture and see it with perspective. For Jews in America and Israel I think it’s doubly hard to recognize our own brand of cutting as being harmful because it is both a cultural and a religious norm. But if you do the research and look at this issue in an openminded and intellectually honest way, it just might “click” that there’s something not right about infant circumcision.

For me, once this shift happened, my perspective changed forever and I could no longer see it as just another parenting choice.

Rebecca Wald, J.D., is the founder of the Beyond the Bris project. She lives in Fort Lauderdale, Florida.

Read full article and comments here

Why My Son Isn't Circumcised


One mother’s stance against infant circumcision
by Jennifer Margulis

My friend Peter, whose parents are Russian, grew up in America with an intact foreskin, as have all the men in his family for generations. But when he became sexually active the foreskin was so tight around the head of his penis that it did not retract easily. Peter’s condition has a name, phimosis, and if you Google “foreskin problems” you’ll find chat groups of young men experiencing similar difficulties asking for advice.

Peter decided to be circumcised as an adult. Circumcision is part of my Jewish cultural heritage. All of my male relatives — my father, uncles, and three older brothers — have been circumcised. In the Bible, God commands Abraham to circumcise his male descendants. Practicing Jews hold a festive ceremony, called a bris, on the eighth day of a boy’s life during which the foreskin is removed either by a doctor or a mohel, a rabbi trained in circumcision. Even in countries where circumcision is not the norm, the majority of Jews choose to circumcise. Despite the problem he had with his foreskin, Peter — a nurse practitioner who advises thousands of patients a year on medical issues — decided not to circumcise his own son when the time came. Peter’s story in addition to the research I’ve done — witnessing the procedure firsthand, talking to men about their feelings — has convinced me that circumcision is not only unnecessary, it’s a painful and traumatizing procedure that should not be done in infancy.

Although in England less than 5 percent of men are circumcised, in America my uncircumcised son is in the minority. According to an article in the New York Times, approximately 79 percent of all adult American males are circumcised. According to Intact America, a nonprofit organization trying to stop routine circumcision, circumcision is one of the most common surgeries performed in America, happening to over 1 million newborns a year, more than 3,000 times a day, once every 26 seconds.

Every parent of an American boy faces a decision about circumcision, though the majority simply chooses to follow the doctor or hospital’s recommendation. Yet most American hospitals do not present circumcision as a choice, they simply assume that parents will opt to circumcise. When my friend Karen’s son, born in Atlanta, was a day old, a nurse bustled in with paperwork. “Ready for his circ?” the nurse asked. Karen looked at her husband. Patrick shrugged, “I guess so,” he muttered, and the baby was taken away. Karen and Patrick assumed the hospital was making the best choice for their child, but they had obviously never discussed it.

Most parents do not watch their baby being circumcised and do not know that the procedure can be excruciatingly painful, even with anesthesia. Anyone who has ever witnessed a circumcision and heard the high-pitched scream of a newborn having part of his penis cut off (you can watch one on the internet if you don't believe me) knows that this surgery causes pain. "It’s wrong to force an irreversible circumcision on a child when he is too young to decide for himself.”

Since the foreskin is attached to the head of the penis (also called the glans) like a fingernail is attached to the nail bed, in order to remove it has to be forcibly pried away. For the week or so that the cut is healing, a baby is peeing and defecating on a raw, open wound. Circumcision can be dangerous. This past March an Atlanta jury awarded $1.8 million in damages to a boy's parents after a seriously botched circumcision. It's also a procedure that can cause lasting regret. My cousin so laments being circumcised that he tries to dissuade the rest of the family from imposing it on our children. Although this is not a subject broached at cocktail parties, when men take the time to talk about having been circumcised, they often regret the loss of their foreskin.

My husband is a good example. James had never really thought about being circumcised himself until our son was born six years ago. After reading up on the subject, he said: “I kind of feel cheated. I could have made my own decision as a teenager if my parents had left well enough alone.” He was horrified to realize that, in order for the penis to heal, the skin of the glans grows a covering, like a callous, to protect it. “It’s appalling. If I’d had the choice, I would have left my body as evolution left it, with functioning parts.”

Other men feel similarly. An economist sent me this email: “Many say the anger only comes from botched surgeries, mine wasn’t. I’m hurt and upset about what happened to me as a baby boy and I have nightmares about it a few times a year. To be strapped to a board and violated like this is one of the most upsetting things that has happened to me in life... and I’m a cancer survivor as well.”

Why circumcise a baby? The trend started in America in large part to keep boys from masturbating. Physicians writing in the 19th century even suggest the surgery should be done without medication so that a child will associate his genitals with pain. In Plain Facts for Young and Old (1882), John Harvey Kellogg writes: “A remedy [for masturbation] which is almost always successful in small boys is circumcision ...The operation should be performed by a surgeon without administering an anaesthetic, as the pain attending the operation will have a salutary effect upon the mind …” Like female genital mutilation, the idea was to make sexual sensations less pleasurable. Is that really what you want to do to your son?

Today arguments in favor of circumcision are supposedly based on scientific research. Recent health studies in Africa suggest that circumcised heterosexual men are less likely to get HIV than non-circumcised counterparts, if they choose not to wear a condom. If they wear a condom, circumcision makes no difference. Proponents also argue that urinary tract infections are less likely, and that it is necessary for cleanliness.

Yet the American Academy of Pediatrics (AAP) claims that the medical data in favor of circumcision “are not sufficient to recommend routine neonatal circumcision,” and most American doctors admit the procedure is not medically necessary. Given the AAP’s stance against recommending circumcision, why do some hospitals encourage or even pressure parents to circumcise? Of course they make money from the procedure, as they do from every medical intervention performed. But there may be another, much more nefarious reason: Human foreskin is used to manufacture artificial skin for burn victims and diabetics, as well as high-end cosmetics. “Where does the supply of foreskins come from?” my husband asks, looking disturbed. “Adult donors?”

The male foreskin is not a superfluous body part; it protects the penis when a boy is a child and also plays a key role in female pleasure when a boy is a man. If there really is a correlation between circumcision and HIV prevention, then we should let adult men choose to have the procedure done once they decide to be sexually active.

Despite a cultural legacy of thousands of years, my husband and I did not circumcise our son. If he chooses to get circumcised as an adult, either for a medical reason or to follow his cultural heritage, that’s his decision. Let’s keep American baby boys intact. It’s wrong to force an irreversible circumcision on a child when he is too young to decide for himself.

Read full article and readers’ comments here

Infant circumcision: Abolish the unkind cut

by Julie Van Orden, Salt Lake Tribune, 1 July 2011

In Loudon Wainwright III’s song “Men,” he says that men are treated as if they were expendable, fodder for wars and drowning ships. Women, in general, stay out of direct combat and join the children on the lifeboats. It is true that our culture expects men to sacrifice, fight, protect. We are not in the habit of reflecting upon where men — and boys — need help, concern, change. Our cultural blinders allow us to inflict upon men what would be considered atrocities if they were inflicted upon women. Nowhere is this more clearly evident than in the practice of circumcision.

American girls are protected by federal law from the cutting and removal of even the slightest bit of their genitalia. Even a ceremonial “nick,” desired by some immigrant cultures, is outlawed. Of course, this is as it should be. Every girl, of every culture, should be able to keep her whole body intact. Yet, as the mother of both a daughter and a son, I have to ask: Why do we treat our boys differently? Why are boys’ bodies less valued in this way? Why is it OK to separate, slice, and sell off part of a boy’s body, often without anesthesia? (The selling of foreskins in America to biomedical companies is a million-dollar industry.) Is it inherent sexism? Is it because, as Wainwright suggests, we are just going to send them off to war anyway?

Fortunately, many parents are realizing just how insane this practice is, and are leaving their sons intact, whole, and just the way that God and/or Mother Nature made them. They are saying “no,” loudly and clearly, to this barbaric cosmetic surgery. They are valuing their newborn sons just as they would their newborn daughters. The circumcision rate is plummeting. Informed parents realize that the risks of circumcision include shock, infection and death. Losing just 2 ounces of blood can be fatal for a newborn. Moreover, 18 states (including Utah) no longer use Medicaid dollars to pay for circumcision. Thus, I fully support the San Francisco ballot measure that would ban the sexist, outdated and harmful practice of routine infant circumcision. My son’s body is as valuable as my daughter’s. Codifying this into law is a civil rights movement of our time.

Source:  Salt Lake Tribune, 1 July 2011

Another U.S. state drops circumcision from its medical benefits schedule

Colorado has become the 18th American state to drop medically unnecessary circumcision from the schedule of medical benefits under the Medicaid program. The decision comes as a result of a campaign by human rights and child protection advocates to protect baby boys from genital cutting, and in response to the budgetary crisis affecting so many American public authorities. When there is little enough funds available for necessary medical procedures, it makes little sense to waste valuable health dollars on unnecessary and harmful operations that the recipients do not want.

Gillian Longley, a registered nurse in Louisville, looks at the change in Medicaid policy as a critical moment for public education surrounding the issue. She said that until recently, new parents were remarkably ill-informed of the pros and cons of circumcision. “Doctors were not giving them the information they needed to make a decision,” she said. “The usual ethical requirements for informed consent were overlooked. Circumcision was a cultural habit that was accepted as normal.”

Colorado lawmakers had to cut hundreds of millions from state spending to balance the budget this year. Halting Medicaid coverage for circumcision is increasingly common across the country and is a relatively easy choice because there is no medical justification for the procedure. “The medical reasons are not convincing either way,” said Dr. Susan Pharo, director of Medicaid and External Pediatric. Research has found a “tiny” benefit in terms of circumcision reducing the frequency of urinary tract infections in the first year of life, Pharo said, “but the numbers are so low it’s not significant.” Some research has found a slight decrease in the transmission of HIV and sexually transmitted diseases among circumcised men in sub-Saharan Africa, “but that’s not really applicable here,” Pharo said, “and the evidence is not strong either way.”

The risks of the procedure include relatively rare incidence of complications such as bleeding and infection and, more commonly, “poor cosmetic effect,” said Dr. Sarah Pilarowski, pediatrician at Cherry Creek Pediatrics. “We do have a lot of baby boys going in later for revisions,” she said. The No. 1 risk is pain. “We try to minimize it,” Pilarowski said, but penile nerve blocks don’t always work and numbing creams “are not 100 percent.”

In fact, the greatest risk of circumcision, experienced by all victims, is the loss of the foreskin, a normal body part that plays a significant role in sexual experience. As Gillian Longley comments, “This is a normal body part,” said Longley. “We are doing our sons a favor to support them to stay whole.” Pilarowski speculates that the changes in Medicaid policies will spark changes in private insurance coverage. “Everyone is looking to cut costs,” she said. “It’s very possible other insurance companies will follow suit.”

Source:  Diane Cameron, Unkindest cut: Medicaid won’t cover circumcision in Colorado, Health Policy Solutions, 21 June 2011

Further information about Medicaid coverage of circumcision in the United States

US circumcision incidence falling steadily - sharp decline in western states

The percentage of male newborns who are circumcised in United States hospitals has dropped drastically. Over a 32-year period, the number of male newborns circumcised in the hospital decreased nationally to 58.3 percent in 2010 from 64.5 percent in 1979, according to new data from the Centers for Disease Control and Prevention. But while that 10 percent decrease over all is statistically significant, the authors of the report say, what leaps out of the data is a 37 percent drop in the West. In that 13-state part of the country, the rate of newborns receiving routine circumcisions at birth fell to 40.2 percent in 2010, by far the lowest rate in the country, from 63.9 percent in 1979. That decline accounts for virtually all of the shift nationwide. The authors cannot explain why the numbers dropped so precipitously in the West, which comprises Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington and Wyoming, because the analysis did not factor in contextual data. But it remains an intriguing question. Why would that part of the country differ so much from the rest? Have parents there developed a new attitude toward circumcision and, if so, why?

The high-profile 2010-11 attempt to get a bill criminalizing the procedure on a San Francisco ballot might have provided an opportunity for opponents of the procedure to reach parents. The initiative — called the Prohibition of Genital Cutting of Male Minors — was ultimately quashed, but it did get 12,000 supporting signatures. “San Francisco is a bastion for new thinking and individual rights, which draws many people to the region; however, the entire West Coast — Washington, Oregon — also have very low infant circumcision rates,” said Lloyd Schofield, the leader of the San Francisco movement. “Certainly much of this comes from basic awareness and less insistence on the procedure from the medical industry.” Mr. Schofield said that “a huge driver of the decline” was the nonpayment for the procedure by private insurers, “but in particular coverage was removed from Medicaid here decades ago.” “When the money is gone,” he said, “it no longer serves a purpose … funny thing about that!”

Douglas Diekema, a member of the American Academy of Pediatrics’ task force on circumcision and a professor of pediatrics at Seattle Children’s Hospital, echoed Mr. Stern’s theory that the difference in circumcision rates could be a result of demographics, but he had another theory, too. “The West Coast has more immigrants from populations that don’t circumcise as commonly as we do in the U.S.,” he said. “The Hispanic culture is one of those, and since the West and Southwest are taking on more Hispanics, one could assume there would be a drop.” At the same time, Dr. Diekema said, West Coast residents tend to be more progressive. “Ever since the founding of this country, the West Coast has attracted people who walk to the beat of their own drummer,” he said. “People here are more likely to question the standard and go a different way.”

Source: Hope Reeves. Circumcision Rates in U.S. Drop Drastically in Western States. New York Times. New York Times, 22 August 2013.

Note: Dr Diekema makes some interesting admissions. First, that the disposition to circumcise is primarily a cultural question, not a medical question at all. Secondly, that the decision not to circumcise is a sign of progressive attitudes and independent thinking. What does that say about people – like him – who favour circumcision? The other big question is why the incidence in the central and north-eastern states has remained steady. Perhaps Mr Schofield’s suggestion holds the key: that it is all about whether routine circumcision is covered by Medicaid (government health insurance). Perhaps this explains why the AAP circumcision report is so keen for circumcision to be a billable procedure.


[ Back to Top ]