Dr. Dean Edell Statement on Circumcision

By Dean Edell, M.D.

I have had a long and vociferous opposition to the practice of routine male circumcision.

While many parents in the 60s, in their zeal to return to nature, abandoned the practice, it was 15 years ago that the birth of my fourth son prompted my rethinking of the issue (my first three sons were circumcised). I had met a nurse, Marilyn Milos, who is now the president of the National Organization of Circumcision Information Resource Centers, who enlightened me to the existing medical data.

The United States was the only country in the world that routinely circumcised its newborn males. It was a uniquely American ritual. The medical evidence never convinced all the other civilized countries in the world. This did not seem to alter the opinions of medical organizations in the United States. They stubbornly clung to the old myths about circumcision.

After analysis of almost 40 years of available medical research on circumcision, the American Academy of Pediatrics issued new recommendations (1999) saying that they do not recommend circumcision as a routine procedure. This is too little and too late for the millions of infants who have undergone this unnecessary and inhumane assault.

This is a radical departure for American medicine and, of course, raises many, many issues. With that statement, the American Academy of Pediatricians joins major national pediatrics groups in England, Australia, Canada, Asia and Europe.

COMMON MYTHS

Let's first talk about the many myths that one hears.

CLEANLINESS

The most common myth is that it's cleaner to be circumcised. It's hard to imagine how this has persisted in an era of soap and running water. But certainly it's understandable that people do get upset with moist places in the body.

A woman's reproductive tract is certainly moist and contains lots of bacteria, yet no one would suggest circumcising females to make them cleaner. Intact boys and children have nothing to 'clean' and a post-puberty man can rinse his penis just as he would wash any other part of his body, and just as a woman washes her genitals.

CERVICAL CANCER

The idea that women who have sex with intact men will get cervical cancer is a myth that is hard to put to rest.

This is so untrue that the Academy did not even consider this in their new evaluation. Cervical cancer is sometimes caused by a virus and has nothing to do with the circumcision status of the male.

URINARY TRACT INFECTIONS

Some studies have found urinary tract infections to be more common in the intact male baby during his first 12 months of life. Other studies have challenged that with findings that demonstrate the opposite to be true - UTIs are higher at any age among circumcised men.

If one accepts the claims of those who think keeping infants intact increases the risk, then you would have to do 200 circumcisions to prevent one urinary tract infection.

COMPLICATIONS

The complication rate of the circumcision operation itself - from bleeding to amputation of the penis - is at least one in 100 according to the American Academy of Pediatrics.

PENILE CANCER

When it comes to penile cancer, the Academy notes that it is so rare that it should not be a significant influence on the decision to circumcise. Body organs that are not amputated may get cancerous cells in them (the breasts, the lungs, and the skin, are organs that are notorious for developing cancers, yet we do not routinely amputate them from our infants). The penis and the prepuce (foreskin), however, are organs that rarely ever become cancerous. An intact man has a greater likelihood of breast cancer than he does penile cancer.

STDs

Sexually transmitted diseases (STDs) have been claimed to be more common in the intact male. But research does not support this myth.

There is no doubt, as the AAP says, that behavioral factors the important factor in determining your risk of STDs and that there are several sexually transmitted diseases that are more common among circumcised men.

FATHER TO SON

The most common reason men give for circumcising their sons is so they will have penises that 'match'. This is simply a poor reason to do such a thing to a newborn baby.

DIFFERENCES: SEXUAL SATISFACTION OF WOMEN

Recent studies have found that sexually, circumcised men are different from intact men. The glans or tip of the intact penis is more sensitive in nerves that give and receive messages from the brain. A man is more able to 'control' his sexual functioning when he remains intact. Circumcision removes the equivalent of 15 square inches of skin, smooth muscle, glands, vessels, and membranes in the adult male. Studies recently (1999) published in the British Journal of Urology found that intact men are more satisfying to their female lovers than circumcised men.

HISTORY

Circumcision was initially introduced into this country by reformers who wanted to prevent masturbation, but according to recent studies, if this was the objective, the reformers have failed.

PREVENT MASTURBATION?

Research published in the Journal of the American Medical Association found that men who are circumcised are more likely to masturbate and to prefer certain sexual practices including oral sex and anal sex. Sexuality meta-analysis studies show that circumcised men masturbate more frequently, and for longer durations, than their intact peers.

It is possible that the decrease in penile sensation that accompanies circumcision could be playing a role in the seeking of different sexual practices that offer more stimulation.

ETHICS

Ethically, the AAP walks a fine line. While they admit that parents and physicians have an ethical duty to act in a child's best interest and well being, they fall far short of recommending that we have an ethical duty to leave a child's genitals intact.

It seems clear to everyone that female circumcision is a gross and obvious violation of this right to genital integrity, but somehow male circumcision is not seen as extreme an intrusion. The AAP does say that, "parents should not be coerced by medical professionals to make this choice."

PAIN

The pediatricians finally admit the obvious: newborns experience extreme pain and significant stress during a circumcision which, unfortunately, is performed most of the time without any analgesia whatsoever.

Why it's taken so long for pediatricians to admit this obvious fact is a clear condemnation of previous circumcision policy. When I was in medical school, doctors tried to teach me that babies don't feel any pain.

SCOPE OF IMPACT

Although it's hard to get numbers, the best that we have tell us that 32 percent of newborns are circumcised in the United States with much lower rates in the West, and slightly higher rates in the Midwest. It's estimated there are 1.2 million newborn males circumcised in the U.S. every year at a cost of between $150 to 270 million. Physicians take in $300-$800 per circumcision surgery.

WHY DO WE PAY?

It seems that, with this newest information, HMO's and other health insurers should stop paying for this medically unnecessary procedure and use that money for other, more important aspects of pediatric care. In fact, in some states, insurance no longer covers circumcision, which is now considered to be cosmetic surgery.

YOU COUNT: TAKE A LOOK AND LEARN MORE

The toughest sell, of course, will be the American public, which is why we are offering you a picture of an infant undergoing circumcision, as well as something half of American men and women have never seen before - an intact, natural baby's penis. It is up to you to become fully informed. [Resources, books, articles, research, websites, and links here.]

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A CHANGING WORLD

Internationally about 89 percent of the male population is intact. The AAP was not the first developed nation in the West, but the fourth major medical society here to change its circumcision policy. Australia, the U.K., and Canada already had instituted humane policies. Hopefully, we will go much further toward stopping this barbaric practice which is decidedly unhealthy for us and our children.



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