The "cure?"
Apr 17 '00 (Updated Apr 19 '01)
The Bottom Line Not necessary, hurts, why do it?
On the day my son was born, a nurse approached me, and asked if I wanted a painful, medically unnecessary surgery performed on my son to remove a healthy, functioning part of his body. I held up my birth plan, pointed at the sign on my son's bassinet, and said, "No." Two hours later, another nurse approached me, singing the praises of unneeded cosmetic surgery. Again, I pointed to my birth plan, nodded toward the sign on the bassinet, and refused. Yet a third nurse entered, and asked in a very demanding tone, "You ARE going to have this done, aren't you?" As if opting to not put my child through a painful and unneeded surgery was a bad thing.
This scene was repeated numerous times during our three-day hospital stay. Repeated enough times that I was terrified of leaving my son in the nursery for even a moment. Sean roomed in 24/7.
I have long opposed routine infant circumcision. Since I first learned of it, first looked at the issue. A thorough examination of the matter left me no choice. I would like to address both the history of circumcision in this country, and the common myths that perpetuate its continued practice.
Circumcision was once practically unheard of in our country–it was a religious rite performed by a few. It was not until the late 1800s that circumcising came into "fashion." It is, as it has always been, a "surgery" looking for medical justification.
In 1860, the Lancet published an article recommending circumcision as both punishment and "treatment" for masturbation. "In cases of masturbation we must, I believe, break the habit by inducing such a condition of the parts as will cause too much local suffering to allow of the practice to be continued. For this purpose, if the prepuce is long, we may circumcise the male patient with present and probably with future advantages; the operation, too, should not be performed under chloroform, so that the pain experienced may be associated with the habit we wish to eradicate." In other words, the aim of circumcision was to stem masturbation by making erection and orgasm painful. Thus began the mad rush to remove a healthy part of male genitalia in England. A practice no longer common in Britain, but one it took 100 years to effectively stamp out.
Enter quackery–fantastical medical claims made in an effort to encourage parents to pay people to remove a healthy, functioning part of their male children. In 1887, Dr. Lewis L. Sayer claimed in the Journal of the American Medical Association that falls and pelvic fractures were caused by the foreskin. "Hip trouble is from falling down, an accident that children with tight foreskins are specially liable to, owing to the weakening of the muscles produced by the condition of the genitals." He recommended circumcision as a way of preventing falls. Yes, that's right. The mind boggles.
Also in 1887, the journal Treatment of Disease in Children continued with the "circumcision as punishment" theme, recommending circumcision and burning of the genitals with lye as a prophylactic against masturbation's "injurous" effects. "There can be no doubt of [masturbation's] injurous effect, and of the proneness to practice it on the part of children with defective brains. Circumcision should always be practiced. It may be necessary to make the genitals so sore by blistering fluids that pain results from attempts to rub the parts."
In 1895, circumcision became even more wondrous, more miraculous a cure. Charles E. Fisher, in the book, "Circumcision, A Hand-Book On the Diseases of Children and Their Homeopathic Treatment, detailed a plethora of benefits to circumcision. "In all cases in which male children are suffering nerve tension, confirmed derangement of the digestive organs, restlessness, irritability, and other disturbances of the nervous system, even to chorea, convulsions, and paralysis, or where through nerve waste the nutritive facilities of the general system are below par and structural diseases are occurring, circumcision should be considered as among the lines of treatment to be pursued."
In 1898, Dr. N. Bergman published an article in the Journal of Orificial Surgery of 1898. In it, he bragged of his "cure" for masturbation. "Clarence B. was addicted to the secret vise practiced among boys. I performed an orificial operation, consisting of circumcision...He needed rightful punishment of cutting pains after his illicit pleasures,"
Ouch. Circumcision as "punishment" for masturbation. Circumcision as protection from terrible illness and disorder. Not an auspicious start, I'm sure you'll agree.
Circumcision became all the rage–a sign of gentle (?) birth and "upper class" status. It didn't take long for this medically unnecessary procedure to become firmly entrenched in our social psyche. Of course, we soon came to realize that the claims of the 19th century were without merit, so we had to create new excuses to perform this useless surgery. Hence the "cleanliness" argument, along with more bogus health claims. Sadly, the masturbation argument never did go away.
In 1920, Dr. L. Solomons claimed in the British Medical Journal that teaching boys to clean themselves was too much effort, and that doing so encouraged masturbation. "Circumcision is an excellent thing to do; it helps to prevent hernia due to straining, and later it helps in preventing masturbation. The ordinary schoolboy is not taught to keep himself clean, and if he is taught he thinks too much of the matter."
In 1928, the Journal of the American Medical Association gave us this kind gem–"Phimosis may be a predisposing cause of masturbation in some cases... Hemorrhage [severe bleeding] following circumcision at birth cannot be considered seriously as a contraindication. Meatal ulcer due to ammoniacal diapers in the circumcised is not a contraindication... Routine circumcision at birth is warranted."
In 1935, R.W. Cockshut (I'm not making that up) published an article in the British Medical Journal advocating circumcision to prevent "teenage copulation" and masturbation. "I suggest that all male children should be circumcised. This is "against nature", but that is exactly the reason why it should be done. Nature intends that the adolescent male shall copulate as often and as promiscuously as possible, and to that end covers the sensitive glans so that it shall be ever ready to receive stimuli. Civilization, on the contrary, requires chastity, and the glans of the circumcised rapidly assumes a leathery texture less sensitive than skin. Thus the adolescent has his attention drawn to his penis much less often. I am convinced that masturbation is much less common in the circumcised. With these considerations in view it does not seem apt to argue that 'God knows best how to make little boys."
By the 1960s, the rate of routine circumcision had soared to near 90%–all without a shred of medical necessity. All without a drop of justification. Doctors got paid for it, and parents listened to doctors without question. A sad state of affairs–especially for infant boys.
By the late 1960s/early 1970s, the medical tide was turning. Unfortunately, what was believed to be "proper" care of the intact penis was actually harmful. Full retraction at birth was considered the "test" of whether or not a child "needed" to be circumcised. Of course, since forced retraction is the leading cause of infection and adhesions, doctors were themselves causing the very infections and damage they claimed circumcision prevented. We still had a long way to go–old habits, even bad ones, die hard. They die harder when the practitioners are paid to continue the practice.
In 1971, the American Academy of Pediatrics issues its Standards and Recommendations for Hospital Care of Newborn Infants, 5th edition, stating plainly that "There are no valid medical indications for circumcision in the neonatal period." Unfortunately, the AAP backed off this statement following a great outcry from those who performed circumcisions. It was not until 1999 that the AAP reiterated its "lack of medical necessity" stance, joining the American Medical Association, the American Cancer Society, the Centers for Disease Control, the National Institutes of Health, the Pediatric Urologists Association, the American College of Obstetrics & Gynecology, the Canadian Pediatric Society, the Canadian Medical Association, and all
European Medical Societies
Wow. Maybe we were finally getting somewhere! Perhaps 100 years of pure "medical" crock was about to be washed away.
Or perhaps not. Despite mounting evidence that circumcision is not medically indicated, that circumcision does not prevent cervical cancer in female partners, that being intact does not increase the risk of infection so long as premature retraction is not performed and proper hygiene is practiced, that the U.S., which has the highest rate of routine circumcision in the world, also has the highest rate of penile cancer in the world, doctors kept right on performing routine circumcision.
Sadly, it took another 20 years for America to catch up.
But we are catching up. We are "catching a clue." More and more parents are recognizing that circumcision is not necessary, it is not medically indicated, and it is not "good" for a child. In fact, NO medical organization in the Western World advocates routine infant circumcision. While the overall routine infant circumcision rate is down to less than 60%, the Western United States enjoys a rate lower than 40%. Unfortunately, the foreskin is still misunderstood, still considered an extraneous flap of skin. This is not true–the foreskin protects the penis, preserves nerve endings and mucosal structures, and provides specialized sensory experience. As a result of this lack of understanding, knife-happy doctors who would never dream of advocating the removal of an infected ear lobe or fingernail leap at the opportunity to remove the foreskin, should the rare infection arise. Considering that infant girls are far more prone to infections of the genitals than are boys, intact and circumcised, I cringe to think what these same doctors would recommend in their cases. But of course, these doctors would recommend antibiotics for girls, for we all know that the removal of a part of a girl's genitals is brutal and wrong. For some strange reason, only our boys are given such treatment.
I often hear the term "personal choice" bandied about when discussing circumcision. I propose that those who use this argument are absolutely right. This is a matter of personal choice. I can't imagine a more personal choice. In fact, it is so personal a choice that I feel it is one best left to the person undergoing the procedure. The person whose genitals are to be forever changed. Just as I would never dream of requesting cosmetic surgery to alter my son's face to change a feature that didn't agree with me, I would never request cosmetic surgery to alter my son's genitals, carving them into a shape more pleasing to me.
Unfortunately, I still hear the "cleanliness" and "cancer" arguments. Caring for an intact infant's penis is no more difficult or time consuming than caring for a circumcised infant's penis. You just wipe. Simple as that. Teaching an older child proper foreskin hygiene is no more difficult than teaching him to wash his hair or scrub those armpits. Retract, rinse, voila! Surely we have enough faith in our sons to trust that they will bathe properly, right? As for the "cancer" argument, I refer you to the letter sent by the American Cancer Society to the American Academy of Pediatrics in February, 1996, which reads, in part, ". . . 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. (this letter can be read in full at http://www.fathermag.com/health/circ/acs/)
Many times, I hear parents offer the "locker room" justification. You know–"I want my boy to look like the other boys?" A few problems with this one:
1) Boys don't tend to spend a lot of time looking at the genitals of other boys in the locker room. I've asked.
2) Boys who are going to be teased will be teased no matter what. Weight, complexion, glasses, grades, proficiency on the basketball court–teasing is teasing, and a foreskin isn't likely to be any more a target than anything else.
3) With the rapidly declining rate of circumcision in this country, an intact boy soon isn't going to be in the minority (and, in fact, isn't in many areas). If the state of one's genitals were a consideration in the locker room, it's the circumcised boys who will "stand out" (no pun intended).
Another argument I've heard is that, if the risk of circumcision is fairly low (and it is), and if it "makes no difference" from a health standpoint, why not? I counter that with "Why?" If given the choice between causing my child hurt or not, I will choose "not." If it is not necessary, if it is not medically indicated, why do it?
The most common argument I hear is, "So he'll look like daddy." Some honest observations:
1) No boy looks like his daddy. I wouldn't have my son's nose carved by a surgeon to make him look like daddy, why would I give his penis that treatment?
2) When was the last time you saw a father and son comparing penises? I asked my husband (who is circumcised) if he recalls comparing penises with his father. The answer was a chuckling "No."
In opening, I spoke of the barrage of queries and demands concerning my decision to leave my son's penis intact. I ask you what those nurses, in effect, asked me. Do you want to put your child through a painful surgical procedure when there is no medical justification for that procedure? I think it's an important question to ask.
NOTE To clear up any misunderstanding, please understand that "routine infant circumcision" is defined as the routine circumcising of infants for non-religious reasons. I have chosen not to address religious circumcision, as I do not believe such an argument would be constructive or civil. My thanks to those who brought the possible confusion/controversy to my attention.
Medical quotes courtesy of "Historical Medical Quotes on Circumcision."
British Journal of Urology (1996), 77, 291-295
The prepuce:
Specialized mucosa of the penis and its loss to circumcision
J.R. Taylor, A.P. Lockwood and A.J. Taylor
Department of Pathology, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada.
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