A Few Thoughts on Circumcision
So I was asked (and have been asked many times) what my thoughts are concerning circumcision. For just a little background, during my month on the pediatric service I performed about 50 circumcisions over approximately 24 working days using both of the Mogen clamp and the gomco.
To start, I must say I think it can be very easy to get caught up in the emotions surrounding this topic. As a father who has two boys, one who is circumcised and who is not, and also as a physician who has performed many circumcisions, I find myself feeling rather neutral on the whole issue. For one, I think the idea that it is a ‘brutal and abusive’ action is a bit overstated. The procedure is actually very quick and clean, with pain medication given to the infant. That doesn’t mean the child doesn’t throw a fit during the procedure, but I have also had many infants act the same way when I was changing their diaper. Infants are fairly easily consoled and are seem to be able to tolerate a fair amount of pain and discomfort for short periods of time. I simply state this, not as justification, but as an observation that reflects that this procedure is not nearly as brutal as many try to make it out to be. So moving beyond the procedure itself, I think it is important to consider the motivations for circumcision.
Many parents do it simply to ensure that the son “looks like his father” or “looks like his brothers”. These motivations exist, for better or for worse, and may not be the best intentions. There are other reasons to be circumcised. Recently the American Academy of Pediatricians issued a policy statement
The policy statement and accompanying technical report from the AAP will be published in the September 2012 issue of Pediatrics (published online Monday, Aug. 27). The documents update the previous policy that the AAP published in 1999 and reaffirmed in 2005.
Since the last policy was published, scientific research shows clearer health benefits to the procedure than had previously been demonstrated. According to a systematic and critical review of the scientific literature, the health benefits of circumcision include lower risks of acquiring HIV, genital herpes, human papilloma virus and syphilis. Circumcision also lowers the risk of penile cancer over a lifetime; reduces the risk of cervical cancer in sexual partners, and lowers the risk of urinary tract infections in the first year of life.
The AAP believes the health benefits are great enough that infant male circumcision should be covered by insurance, which would increase access to the procedure for families who choose it.
“Ultimately, this is a decision that parents will have to make,” said Susan Blank, MD, FAAP, chair of the task force that authored the AAP policy statement and technical report. “Parents are entitled to medically accurate and non-biased information about circumcision, and they should weigh this medical information in the context of their own religious, ethical and cultural beliefs.”
Pediatricians are one of the major providers of circumcisions (along certain groups of family physicians and some obstetricians). This is not about generating more revenue or business, because in most cases I think it would be safe to say that pediatricians would prefer to avoid the trouble of circumcision. This new statement, in my humble opinion, is a reflection of evidence based medicine. But note that the AAP still states that the final decision is to be left in the parent’s hands (now if only they would approach vaccines the same way….).
With that said, I think we need to keep a few historical, and biblical, facts in mind. For one, Jesus was circumcised. In fact, many of us still celebrate the Feast of the Circumcision on the eighth day after Christmas. Also, circumcision is never condemned in scripture, rather Paul writes “In Christ Jesus neither circumcision availeth any thing, nor uncircumcision: but faith that worketh by charity” (Galatians 5:6) So basically, it doesn’t matter if you are or are not, as long as your faith and salvation are in Christ.
I do not think it is a procedure that should be banned, nor should parents be condemned for having it done. Nor should the uncircumcised (or their parents) be shunned or ostracized either. This really comes down to parental choice, a choice that should be made with full knowledge of the risk and benefits of the procedure, and a reasonable motivation for having it done.
Let me know if you have more specific questions regarding this topic.
Once again, thank you for your attention!