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Circumcision Awareness

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The Case Against Circumcision
Paul M. Fleiss, MD

"Routine circumcision of babies in the United States did not begin until the Cold War era. Circumcision is almost unheard of in Europe, Southern America, and non-Muslim Asia. In fact, only 10 to 15 percent of men throughout the world are circumcised."
"The natural penis requires no special care. A child's foreskin, like his eyelids, is self-cleansing. Forcibly retracting a baby's foreskin can lead to irritation and infection. The best way to care for a child's intact penis is to leave it alone."

The Foreskin Is Necessary

By Paul M. Fleiss, MD, MPH

       Western countries have no tradition of circumcision. In antiquity, the expansion of the Greek and Roman Empires brought Westerners into contact with the peoples of the Middle East, some of whom marked their children with circumcision and other sexual mutilations. To protect these children, the Greeks and Romans passed laws forbidding circumcision.1 Over the centuries, the Catholic Church has passed many similar laws.2,3 The traditional Western response to circumcision has been revulsion and indignation.

       Circumcision started in America during the masturbation hysteria of the Victorian Era, when a few American doctors circumcised boys to punish them for masturbating. Victorian doctors knew very well that circumcision denudes, desensitizes, and disables the penis. Nevertheless, they were soon claiming that circumcision cured epilepsy, convulsions, paralysis, elephantiasis, tuberculosis, eczema, bed-wetting, hip-joint disease, fecal incontinence, rectal prolapse, wet dreams, hernia, headaches, nervousness, hysteria, poor eyesight, idiocy, mental retardation, and insanity.4

       In fact, no procedure in the history of medicine has been claimed to cure and prevent more diseases than circumcision. As late as the 1970s, leading American medical textbooks still advocated routine circumcision as a way to prevent masturbation.5 The antisexual motivations behind an operation that entails cutting off part of the penis are obvious.

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Infant Male Circumcision is Not in the Best Interests of the Health & Rights of the Child

FACT SHEET

Scope of the Problem
  • Current national rates: Australia 15%(1), Canada 20%(2), the United States 60%(3).
  • In the U.S., over 1.25 million infants annually - more than 3,300 babies each day - one child every 26 seconds.
  • The surgery wastes more than $250 million health care dollars annually(4) as well as untold personnel hours.
  • Globally, 20% of male children will be subjected to some form of non-medically indicated genital mutilation.(5)
Early and Current Rationale
  • (U.S.) physicians thought it logical to perform genital surgery on both sexes to stop masturbation. This rationale was initiated in the English-speaking countries during the 19th Century.(6)
  • The current medical rationale for circumcision developed after the operation was in wide practice.(7) To make sons resemble their circumcised fathers, to conform socially with peers, to improve hygiene, to prevent phimosis, and as prophylaxis for infant urinary tract infections, sexually transmitted diseases, AIDS, and cancer of the penis/cervix.(8)
Decision Making
  • The circumcision decision in the U.S. is emerging as a cultural ritual rather than the result of medical misunderstanding among parents. It is more an emotional than a rational decision.(9)
  • Other factors affect parents’ decisions, including esthetics, cultural attitudes, social pressures and tradition.(10)
  • Ultimate decision may hinge on non-medical considerations.(11) Circumcision has become cultural surgery.(12)
Foreskin Function
  • When infant is incontinent, prepuce fulfills an essential function, to protect the glans.(13)
  • The foreskin is more than just penile skin necessary for a natural erection; it is specialized tissue, richly supplied with blood vessels, highly innervated, and uniquely endowed with stretch receptors. (T)he foreskin contribute(s) significantly to the sexual response of the intact male.(14)
  • This mucous-membrane contact [male foreskin and female labia] provides natural lubrication...and prevents dryness responsible for painful intercourse and chafing and abrasions that allow for entry of STDs, viral/bacterial.(15)
Penile Development
  • Development of the prepuce is incomplete in the newborn male child, and separation from the glans, rendering it retractable, does not usually occur until some time between 9 months and 3 years.(16)
  • (Infant) circumcision...traumatically interrupts the natural separation of the foreskin from the glans.(17)
  • Circumcision interferes with penile development, surgeon must tear skin from sensitive glans to permit removal.(18)
Immediate Risks and Complications
  • Complications are often overlooked or un(der)reported. Lacerations, skin loss, skin bridges, chordee, meatitis, stenosis, urinary retention, glans necrosis, penile loss, hemorrhage, sepsis, gangrene, meningitis.(19)
  • Literature abounds with reports, morbidity and death from circumcision Realistic (complication) figure is 2-10%.(20)
Long-Term Adverse Outcomes
  • Poor surgical result is not recognized until years later. Adverse consequences of infant circumcision on men’s health must be recognized by physicians, parents & legislators.(21)
  • Circumcision is a subtraction, removing one-third or more of entire penile skin - tragic loss of erogenous tissue.(22)
  • When sexually functioning tissue is removed, sexual functioning is altered. Penile changes are documented.(23)
  • Of 313 circumcised male respondents, 49.5% cited a sense of parental violation, 62% expressed feelings of mutilation, and 84% reported some degree of sexual harm [progressive loss of glans sensitivity, excess stimulation needed to reach orgasm, painful coitus and impotence].(24)
  • Body image survey found 20% of circumcised respondents cited dissatisfaction with their circumcision.(25)
Effects of Pain
  • Newborn infant responses to pain are similar to but greater than those in adult subjects. The persistence of specific behavioral changes after circumcision in neonates implies the presence of memory.(26)
  • Infant circumcision causes severe, persistent pain. Acetaminophen does not ameliorate pain of circumcision.(27)
  • Main structures for memory are functional in neonates and circumcision pain may have long-lasting effects.(28)
Maternal Bonding / Breastfeeding
  • Circumcision affects mother-infant interaction.(29)
  • When an infant is subjected to intolerable, overwhelming pain, it conceptualizes mother as participatory and responsible regardless of mother’s intent. Consequences for impaired bonding are significant.(30)
  • These are the first data suggesting a protective effect of breastfeeding against UTI.(31)
  • Breasts also produce large quantities of a hormone (GnRH) that may aid in development of a newborn’s brain.(32)
  • Infants feed less frequently after circumcision; observed deterioration may contribute to breast- feeding failure.(33)
  • A stressful, painful event such as circumcision appears to affect the feeding patterns.(34)
Questionable Benefits
  • Good hygiene can offer many advantages over circumcision.(35)
  • Circumcision has no significant effect on the incidence of common sexually transmitted diseases (STDs).(36)
  • Circumcision is not harmless and cannot be recommended without unequivocal proof of benefit.(37)
  • Not one confirmed UTI case in a normal male infant. All cases in infants with clear urinary birth defects.(38)
  • Antimicrobial management of UTI in infants is routine and outcome generally good. It is inappropriate at this time to recommend circumcision as a routine medically indicated procedure.(39)
  • Reported benefits in preventing cancer and infant UTIs are insignificant compared to surgical risks.(40)
  • Performing 100,000 mutilative procedures on newborns to possibly prevent cancer in one elderly man is absurd.(41)
Medical Ethics
  • It must be recognized that the child is normal as born and that circumcision inflicts loss of a normal body part and leaves a scar. This is contrary to the motto of medicine, “First Do No Harm.”(42)
  • The unnecessary removal of a functioning body organ in the name of tradition, custom or any other non-disease related cause should never be acceptable to the health profession...and breaches fundamental medical ethics.(43)
  • Children too young to give consent must be treated as individuals. The child must live with the outcome of decision.(44)
Obstetrical Involvement
  • Seventy-four percent (74%) of the Ob/Gyns surveyed perform circumcision. Ob-Gyn fees for circumcision range to $400, averaging $137 nationwide.(45)
  • Ob-Gyns not aware of preputial structure & function or growing numbers of men undergoing foreskin restoration.(46)
Restoration Movement
  • In North America many circumcised men are now becoming aware of the mutilation and the harm this has done to them, and some are seeking methods of replacing the lost prepuce.(47)
  • At the root of this reaction lies an awareness that a perfectly normal, healthy -- indeed, the most sensually responsive -- part of their penis was surgically amputated when too young/helpless to consent, refuse or resist.(48)
Children’s Rights
  • All childhood circumcisions are violations of human rights. ...It is the moral duty of educated professionals to protect health and rights of those with little or no social power to protect themselves.(49)
  • Circumcision is an issue of self-determination and autonomy.(50)
  • Imperative that children have the right to own their reproductive organs and to preserve natural sexual function.(51)
  • Circumcisions for personal preference of the parent(s) deny the infant the basic right to respect and autonomy.(52)
  • Every circumcision...is an assault on a child’s sexuality and a violation of his right to an intact body.(53)
Why Does It Continue?
  • Americans culturally acclimated/regard foreskin as non-essential, pathologic.(54)
  • Cultural, social and historical perspectives around infant circumcision control physicians and parents.(55)
  1. Average of state and territory circumcision rates NOCIRC of Australia
  2. Average of provincial circumcision rates compiled from Health & Welfare Canada and Statistics Canada
  3. Average of regional circumcision rates compiled by National Center for Health Statistics
  4. updated from Rockney, R. Newborn Circumcision. American Family Physician, October 1988:151-155
  5. Wallerstein, E. Circumcision: Uniquely American Medical Enigma. Urol. Clinics of N America, February 1985;12:123-132
  6. Milos, M. Circumcision: Male - Effects on Human Sexuality. Human Sexuality: Ency.. NY, Garland 1994:119-121
  7. Paige, K. The Ritual of Circumcision. Human Nature, May 1989:40-48
  8. paraphrased from Report of the Task Force on Circumcision. Pediatrics, August 1989; 84:388-391
  9. Brown. M. Circumcision Decision: Prominence of Social Concerns. Pediatrics, August 1987;80:215- 219
  10. Report of the Task Force on Circumcision. Pediatrics, August 1989;84-388-391
  11. Poland, R. Question of Routine Neonatal Circumcision. New England Journal of Med, May 1990;322:1312-1314
  12. Wallerstein, E. Circumcision: Uniquely American Medical Enigma. Urol Clinics of N Amer, Feb 1985;12:123-132
  13. Gairdner, D. Fate of the Foreskin. British Medical Journal, December 1949:1433-1437
  14. Milos, M. Circumcision: Male - Effects on Human Sexuality. Human Sexuality: An Encyclopedia
  15. Ibid.
  16. Gairdner, D. Fate of the Foreskin. British Medical Journal, December 1949:1433-1437
  17. Milos, M. Circumcision: Male - Effects on Human Sexuality. Human Sexuality: An Encyclopedia
  18. Denniston, G. Unnecessary Circumcision. The Female Patient, July 1992;17:13-14
  19. Marshall, F. Complications: Pediatric Circumcision. Urol. Complic. Med-Surg. NY, Year Bk Med. 1986:387-395
  20. Williams, N. Complications of Circumcision. British Journal of Surgery, October 1993;80:1231-1236
  21. Snyder, J. The Problem of Circumcision in America. Truth Seeker, July 1989:39-42
  22. Ritter, T. Circumcision Removes More Than a little Snip. Say No to Circumcision. Aptos, Hourglass 1992:18-1
  23. Milos, M. Circumcision: Male - Effects on Human Sexuality. Human Sexuality: An Encyclopedia
  24. Hammond, T. Awakenings: Prelim. Poll of Circ. Men. NOHARMM 1992:76-77 [POB 460795, San Franc., 94146]
  25. Ibid.:73-75
  26. Anand, KJS. Pain and its Effects on the Human Neonate and Fetus. New Engl J of Med, 1987;317:1321-1329
  27. Howard, C. Acetaminophen Analgesia in Neonatal Circum.:Effect on Pain. Pediatrics, Apr 1994;93:641-646
  28. Taddio, A. Effect Neonatal Circum. on Pain Responses at Vaccination in Boys. Lancet, Feb. 1995;345:291-292
  29. Marshall, R. Circumcision: Effects on Mother-Infant Interaction. Early Human Development, 1982;7:367-374
  30. Laibow, R. Circ: Relationship Attachment Impairment. NOCIRC Intl Symp. on Circumcision., San Francisco April 1991:14
  31. Piscane, A. Breastfeeding and Urinary Tract Infection. Lancet, July 7, 1990:50
  32. Koch, Y. Hormone in Breast Milk May Help Babies Develop. reported in Wash. Post - Health, May 24, 1994:5
  33. Howard, C. Acetaminophen Analgesia in Neonatal Circum.:Effect on Pain. Pediatrics, Apr 1994;93:641-646
  34. Marshall, R. Circumcision: Effects on Mother-Infant Interaction. Early Human Development, 1982;7:367-374
  35. Krueger, H. Effects of Hygiene Among the Uncircumcised. Journal of Family Practice, 1986;22:353-355
  36. Donovan, B. Male Circumcision & Common STDS in Developed Nation Setting. Genitourin Med, 1994;70:317-320
  37. Thompson, R. Routine Circumcision in the Newborn. Journal of Family Practice, 1990;31:189-196
  38. Altschul, M. Cultural Bias and the UTI Circumcision Controversy. Truth Seeker, July 1989;1:43-45
  39. McCracken, G. Options in Antimicrobial Mgmt. UTI in Infants-Children. Ped Infect Dis J, Aug 1989;8:552-555
  40. Lawler, F. Circumcision: Decision Analysis of its Medical Value. Family Medicine, 1991;23:587- 593
  41. Denniston, G. Unnecessary Circumcision. The Female Patient, July 1992;17:13-14
  42. Snyder, J. The Problem of Circumcision in America. Truth Seeker, July 1989:39-42
  43. Toubia, N. FGM: Responsibility of Reproductive Health Professionals. Intl J of Gyn & Obst, 1994;46:127-135
  44. Shield, JPH. Children’s Consent to Treatment. British Medical Journal, May 1994;308:1182-1183
  45. Garry, T. Circumcision: A Survey of Fees and Practices. OBG Management, October 1994:34-36
  46. Sorger, L. To ACOG: Stop Circumcisions. Ob.Gyn. News, November 1, 1994:8
  47. Warren, J. The Case Against Circumcision. British Journal of Sexual Medicine, September 1994;21:6-8
  48. Bigelow, J. Uncircumcising: Undoing Effects of Ancient Practice in Modern world. Mothering, Sumr, 1994:56-61
  49. Toubia, N. FGM: Responsibility of Reproductive Health Professionals. Intl J of Gyn & Obst, 1994;46:127-135
  50. Phillips, I. Advocacy: Rhetoric or Practice. Nursing BC, August 1994:38
  51. Milos, M. Circumcision: Male - Effects on Human Sexuality. Human Sexuality: An Encyclopedia
  52. Phillips, I. Advocacy: Rhetoric or Practice. Nursing BC, August 1994:38
  53. Sperlich, B. Botched Circumcisions. American Journal of Nursing, June 1994;94:16
  54. Altschul, M. Circumcision Controversy. AFP-American Family Physician, March 1990;41:817-821
  55. Stein, M. Routine Circum.: Gap Between Contemporary Policy and Practice. J of Fam Pract, 1982;15:47-53

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