Circumcision used to be routine and noncontroversial in the United States. But in the 1980s and 1990s, opposition grew to the point that the procedure became demonized as barbaric and medieval. As a result of this pressure, the American Academy of Pediatrics characterized circumcision as “nontherapeutic” in 1999 (although it has never officially discouraged its use).
Vociferous “NO-CIRC” critics of circumcision are currently trying to have the procedure completely banned, even for religious reasons. Despite their efforts, circumcision rates remain at about 50 percent in the United States.
The actual procedure is fairly simple. After a numbing cream is applied to the penile foreskin, a significant portion is excised. It is usually performed in the first few days after birth.
Healing is rapid and generally uneventful.
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Why are babies circumcised? That is an extremely complex question involving religious, social and medical ramifications. I wish to speak only to the medical aspects, particularly debunking some myths put out by the NO-CIRC advocates.
Myth: There are no valid medical reasons to circumcise males.
Wrong. Several studies have shown significant medical value to circumcision including the following:
1. Male circumcision lowers human papilloma virus (HPV) infection in female partners. One study from five countries in 2002 found HPV present in 20 percent of uncircumcised men and in only 6 percent of circumcised men. Another study in South Africa in 2008 found circumcised men to be half as likely to have HPV as uncircumcised men. Why is this important? Because HPV is responsible for genital warts and for almost all cases of cervical cancer. Researchers surmise that circumcision could reduce cervical cancer rates from 23 percent to 43 percent worldwide, saving thousands of lives.
2. Male circumcision confers an element of protection from HIV. A U.S. Centers for Disease Control researcher tested high-risk African-American men in Baltimore in 2010, and found that HIV was present in 22 percent of the uncircumcised men, compared to only 10 percent of the circumcised ones.
These results are compelling for any woman who seeks to lower her risk of developing HIV, cervical cancer and HPV infection.
Myth: The foreskin is a valuable piece of tissue that has protective and immunological functions.
Not really. Were this true, then we would expect that retaining the foreskin would provide some element of immunological protection. But STD and urinary tract infections (except for an increased HIV and HPV risk for the uncircumcised, as mentioned above) are basically similar for circumcised and uncircumcised males. Even the risk of penile cancer, which is extremely rare, is unchanged by circumcision.
Myth: The care of an intact penis is the same as a circumcised penis.
The NO-CIRC proponents fail to address some practical differences in the medical care of those who possess a foreskin and those who don’t.
The foreskin can become swollen and squeeze around the penis in a painful and occasionally dangerous fashion (called paraphimosis). Similarly, it can swell to the point of being nonretractable, thus obstructing urine outflow (called phimosis). Both conditions only occur in those males with intact foreskins. In my career as an emergency physician, I have seen many, many patients presenting to the emergency room with phimosis or paraphimosis, in addition to a significant number presenting with infections surrounding the foreskin (usually secondary to poor hygiene). The care and risks are not the same.
Myth: Circumcision is extremely painful and barbaric.
NO-CIRC advocates’ claim that circumcision increases future pain thresholds is based on emotion and not any consistent statistical evidence.
I was circumcised as an infant and have zero recall of the event, despite the fact that it was performed back in the days when no anesthesia was used. In fact, no one remembers their circumcision — just as we don’t remember our births, or our immunizations, or other painful procedures surrounding our infancy. Removing foreskin to lessen female partner risks of HIV and cervical cancer seems no more barbaric than removing an infected appendix — two procedures based on facts and not emotion.
Dr. Steven Sainsbury has a private medical practice in San Luis Obispo.