Neonatal Circumcision (Controversy? Who, Moi?)
I read an article in yesterday's paper about the decline in neonatal circumcision. Apparently fewer and fewer baby boys undergo the procedure each year, with the overall rate now standing at 57%, down from a high of nearly 90% in the early 1960's. Immigration patterns are felt to play the biggest role in the decline, but a fair number of parents who once would have had their infants circumcised routinely are re-thinking the procedure -- and refusing.
I think this is a bad thing.
For what it's worth, so do many others. Evidence is accumulating that circumcision is protective against HPV and HIV infection (and therefore against cervical dysplasia and the spread of HIV in the partners of circumcised men) in addition to penile cancer, a rare condition estimated to affect fewer than 1300 men in 2007.
Part of the problem is that several medical organizations have officially renounced neonatal circumcision, most notably the American Academy of Pediatrics:
Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. If a decision for circumcision is made, procedural analgesia should be provided. (emphasis mine)The American Academy of Family Physicians takes a more generic approach:
The decision to perform neonatal circumcision should be based on the informed consent of the parents, and requires objective, factual counseling of parents by the family physician.The American College of Obstetricians and Gynecologists is even less definitive:
Newborn circumcision is an elective procedure to be performed at the request of the parents on baby boys who are physiologically and clinical stable.The problem is that pediatricians don't have to deal with the repercussions of these decisions decades later. Adult circumcision required urgently or emergently for things like phimosis (a "stuck" foreskin that can't be retracted) or a paraphimosis (a foreskin stuck in the retracted position) is a huge undertaking compared to the two minute procedure for a neonate. And yet interestingly, no one seems to have thought of asking the urologists their opinion (except the pediatric ones, and by definition they don't see adults), probably because they aren't the ones doing the procedures. That's a shame, because almost all the urologists I know recognize that the overall benefits of circumcision outweigh the risks, and that the lowest risk time to undergo the procedure is in the neonatal period.
(Another thought: could the increasing incidence of cervical HPV disease in women in recent years be a consequence of the declining circumcision rates?)
Now for those of you who thought the chronic lyme community was, shall we say, passionate, let me just point out that you ain't seen nuttin'. There are multiple, well-organized groups arrayed against this "male mutilation" who are probably going to come out swinging. I've read many of their sites, as well as their criticism of some of the studies linked above, and their own "research" on the subject. They sound like alties, cherry-picking evidence and refusing to acknowledge any findings that contradict their pre-determined conclusions.
They wax eloquent about the joys of the foreskin and the alleged greater sexual pleasure provided by an intact phallus. Then again, the vast majority of circumcised men seem perfectly content with their sex lives, at least vis-a-vis their foreskin status. I am of the firm belief that the vast majority of sexual problems are due to derangements in the large head above the shoulders, not the presence or absence of tissue on the little head between the legs.
I don't have a problem with anyone disagreeing with me. I would just like to see some intellectual honesty brought to the discussion, with a response like, "I understand my little boy (and his sex partners) will be at higher risk for some health problems later in life as a result of this decision we're making for him, but it's a risk we choose to accept for him."
*stepping aside, waiting for the fur to fly*