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Moms Talk: Is Circumcision Necessary?

This week's Mom's Talk discusses this controversial issue for mothers.

Circumcision has been common practice in many cultures for thousands of years. It was introduced to most cultures through religious beliefs and rituals. Throughout history it has been used for religious reasons and to prevent disease. In the United States, it is now done to prevent disease and for aesthetic purposes.

For an historical look at circumcision, click here.

When I was pregnant with my son I realized that most of what’s available on the Internet about circumcision is contradictory. There is childish bickering on forums, and Web sites are full of claims, but few real facts.

I needed answers on the topic.

My OB-GYN told me to talk to a pediatrician, and the pediatrician’s receptionist handed me a brochure that appeared to have been printed in the 1980’s. Confused and frustrated at the lack of information I decided to turn to only reliable and credible sources on the internet. I went to the CDC’s website. Click here for the CDC's facts on the subject.

What I found there was interesting. To sum it up, if I understand correctly, the risks of circumcision are very minimal (“In large studies of infant circumcision in the United States, reported inpatient complication rates range from 0.2 percent to 2 percent”).

There seems to be some evidence that it reduces the risk of contracting H.I.V. and a few other sexually transmitted diseases, according to the CDC. “Lack of male circumcision has also been associated with sexually transmitted genital ulcer disease and chlamydia, infant urinary tract infections, penile cancer and cervical cancer in female partners of uncircumcised men. The latter two conditions are related to human papillomavirus (HPV) infection. Transmission of this virus is also associated with lack of male circumcision. A recent meta-analysis included 26 studies that assessed the association between male circumcision and risk for genital ulcer disease. The analysis concluded that there was a significantly lower risk for syphilis and chancroid among circumcised men, whereas the reduced risk of herpes simplex virus type 2 infection had a borderline statistical significance."

When it comes to sexual sensitivity, even the CDC seems unclear of the answer stating, “Well-designed studies of sexual sensation and function in relation to male circumcision are few, and the results present a mixed picture."

Hygiene is also something that is heavily discussed in the circumcision debate, but it seems to me that with a bit of effort, good hygiene is not difficult either way.

Although there seem to be some benefits, it seems clear to me that circumcision is not medically necessary. On the other hand it has been common practice for thousands of years. What was the deciding factor in your decision to either circumcise or not circumcise your son?

Note: I have seen many debates on the subject on the Internet. I understand many of you will be passionate about your opinions but please respect the views and opinions of others.

Jakew April 20, 2011 at 07:49 AM
"Jake, you want people to believe you are some impartial party, who is merely pro-parental choice. That is not the case." -- pro-parental choice isn't impartial, Thomas. It's a viewpoint like any other. It's less extreme a viewpoint than pro- or anti-circumcision, but make no mistake, it's still a viewpoint. "You participate with the most active pro-circumcision forces in the world, in what can only be called an unreasoning, illogical, and flawed manipulation of data." -- care to justify these accusations? "Why is it that most of Europe has foreskins, but their rates of HIV infection are considerably lower than that of mostly circumcised USA?" -- better rates of sex education and condom use seem the most likely explanation. Do you want some references? "You recently stated that the circumcision rate in Finland was 7%. The last figure I saw for it was 0.09%. That is wrong by orders of magnitude." -- it's 7.1%. "Here is more of your drivel." -- here you're listing some of my peer-reviewed publications, another Patch thread, and a forum post that I didn't write, and collectively describing them as "drivel", with no justification or explanation. I don't know what you're trying to achieve - that's not even an argument.
Jakew April 20, 2011 at 07:54 AM
"You are pro-parental choice. Others, such as myself, are anti-parental choice on this matter. Why? Because the procedure is unnecessary at birth." -- unnecessary, yes, though we evidently disagree over whether that's a reason to oppose something. "You need to understand that restoration is by no means the same thing as not being circumcised" -- nor is adult circumcision the same thing as infant circumcision. It invariably produces, for example, heavier scarring due to sutures & the remarkable healing ability of the infant body. "So by being pro-parental choice, you are inherently being anti-autonomy" -- no, as I explained above, if I were anti-autonomy I'd have to oppose an adult's ability to choose to be circumcised. That's what it means. If you want a brief but accurate summary instead, how about this: I oppose the notion that there is a right to a foreskin.
Thomas Tobin April 20, 2011 at 12:42 PM
Jake, you are not pro-parental choice. You are pro-circumcision. You insist that the right of parents to amputate this one specific part of a child, but no other, trumps the child's right to keep all of his healthy body parts. Name another healthy living body part which is commonly removed. I thought so. Why would a gay man have a vested interest in parental rights? Perhaps you can dig yourself a hole with that one. For those who missed it, here it is again. http://sydney.edu.au/medicine/genetic/staff/profiles/bmorris.php Morris, B., Bailis, S., Waskett, J., Wiswell, T., Halperin, D. Medicaid coverage of newborn circumcision: a health parity right of the poor. American Journal of Public Health. 2009. p. 969-971. Even poor children have the right to have a healthy body part involuntarily removed. US rate is 00.60, Belgian rate is 00.20. 3 times the rate for a mostly circumcised country, than the rate of a country with foreskins. Europe is not known for its fondness for using condoms. Belgium and Denmark are at 00.20, Greece at 00.20, and Finland and Germany are at 00.10. http://en.wikipedia.org/wiki/List_of_countries_by_HIV/AIDS_adult_prevalence_rate
Thomas Tobin April 20, 2011 at 12:42 PM
Care to cite a source for the Finnish circumcision rate being 7.1%? Denniston reported in 1996 that the neonatal circumcision rate in Finland is zero and that the rate of later circumcision is 1 in 16,667. Schoen et al., however, reported in 2006 that data from 1996–1998 indicate a circumcision rate of about 7.1% AHA. The Finns themselves say 710 nationwide cases in 2002. In 2002, the population was 5,206,295. http://en.wikipedia.org/wiki/Prevalence_of_circumcision Jake, I counted 160+ entries posted by you in here, since April 1st. You have an obsession, whether or not you care to recognize it.
Jakew April 20, 2011 at 02:58 PM
"Care to cite a source for the Finnish circumcision rate being 7.1%?" -- certainly, there are two such sources: Schoen EJ, Colby CJ, To TT. Cost analysis of neonatal circumcision in a large health maintenance organization. J Urol. 2006 Mar;175(3 Pt 1):1111-5 and Houle AM. Circumcision for all: the pro side. Can Urol Assoc J. 2007 Nov;1(4):398-400. "Jake, I counted 160+ entries posted by you in here, since April 1st. You have an obsession, whether or not you care to recognize it." -- thank you for your diagnosis, Thomas. :-)
Jakew April 20, 2011 at 03:59 PM
"Jake, you are not pro-parental choice. You are pro-circumcision." -- no, I'm pro-parental choice. It's really bizarre to find myself in an argument about this: I *know* my viewpoint, you are clearly guessing, and wrongly. But what's really odd is that you're investing so much effort into arguing about my viewpoint. Why is it so important to you that I be pro-circumcision? Whatever labels you attach to me, I'm not arguing that anybody should circumcise their sons, so if you want to pick a fight over that you're out of luck. "Name another healthy living body part which is commonly removed." -- I don't believe that there are any such parts. As I've noted previously, circumcision is unique in terms of its risk-benefit balance. "Why would a gay man have a vested interest in parental rights?" -- homophobia. Interesting. "US rate is 00.60, Belgian rate is 00.20. 3 times the rate for a mostly circumcised country, than the rate of a country with foreskins" -- tell me, do you think that comparing aggregate data in this way is a legitimate approach to determining the effect of circumcision? Does it isolate the effect of that which you're trying to measure? Should epidemiologists abandon more sophisticated designs and just look at a table when trying to assess the impact of something? (continued)
Jakew April 20, 2011 at 03:59 PM
"Europe is not known for its fondness for using condoms." -- sure about that? Michael RT, et al. Private sexual behavior, public opinion, and public health policy related to sexually transmitted diseases: a US-British comparison. Am J Public Health. 1998 May;88(5):749-54. Weinberg MS, et al. AIDS risk reduction strategies among United States and Swedish heterosexual university students. Arch Sex Behav. 1998 Aug;27(4):385-401. Brick P. How does Europe do it? Fam Life Matters. 1999 Winter;(36):3
Stan Barnes April 20, 2011 at 09:45 PM
It is clear from your response that you are more interested in justifying and promoting an outdated and harmful cultural/religious practice than you are in the health and well being of children. If the health and well being of children were your top priority, you would focus on effective, non-invasive methods of prevention and treatment instead of focusing on cutting off normal parts of healthy children's genitals.
Stan Barnes April 20, 2011 at 09:54 PM
Pro-circumcision accurately describes anyone who thinks it is ethical for someone else to cut off a normal, healthy part of my penis without my consent and without a compelling medical reason. The so-called pro-parental choice point of view is a subset of the pro-circumcision point of view. Central to the line that divides this debate is a male's right to make all decisions that permanently modify his body when there is no compelling medical reason for the permanent body modification.
Stan Barnes April 20, 2011 at 10:05 PM
Josh: "So by being pro-parental choice, you are inherently being anti-autonomy" Jake: "no, as I explained above, if I were anti-autonomy I'd have to oppose an adult's ability to choose to be circumcised. That's what it means. If you want a brief but accurate summary instead, how about this: I oppose the notion that there is a right to a foreskin." You do not understand the meaning of autonomy. If a person has autonomy over their own body, they make the decisions that affect their body, not some other person. An adult male who decides to permanently modify his own body is exercising his bodily autonomy. When a parent decides to permanently modify the body of their child, they violate the child's right to bodily autonomy.
Thomas Tobin April 21, 2011 at 12:58 AM
Jake, can you do math? What is 710 times 100, divided by 5,206,295? I cheated, and used a calculator. That's right. No matter what Edgar Schoen says, by the Finns themselves, the percentage for 2002 was 0.013637337. Please feel free to check the sources I cited, and run the numbers yourself. If you find that they are incorrect, please let us know. If not, please let Dr. Schoen and Mr. Houle know. You've heard of duck typing. As far as you being either pro-circumcision, well, perhaps you are. Perhaps circlist is not a circumcision fetish organization. Perhaps you are genuinely interested in the well being of children. Perhaps you indeed are the only pro-parental choice proponent, writing with a bunch of pro-circumcision zealots. The chances of all of these these things coming together, in the same person, at the same time, are stacked astronomically. Like, one in several billion trillion. If it walks like a duck... Homophobe? It's possible. I hold hands with men, and kiss them. I think if you asked them, the answer would be "no, he's not". I don't find homophobia interesting. I find it repulsive, and revealing. Truth be told, though, when someone tells me he's doing it for the children, and it causes them excruciating pain, I am forced to wonder, and even more so, when he's gay. Do you have facts refute my numbers regarding European vs American HIV infection rates? Are you saying I should believe the epidemiologists over experience and reason + fact?
Jakew April 21, 2011 at 07:27 AM
Stan, this is a discussion about circumcision, so of course I will focus on that subject. If it were a discussion about disease prevention then it would be different, but it isn't.
Jakew April 21, 2011 at 07:29 AM
"Pro-circumcision accurately describes anyone who thinks it is ethical for someone else to cut off a normal, healthy part of my penis without my consent and without a compelling medical reason." -- no, it doesn't. It only describes those who believe that circumcision *should* be performed.
Jakew April 21, 2011 at 07:39 AM
"You do not understand the meaning of autonomy. If a person has autonomy over their own body, they make the decisions that affect their body, not some other person" -- so, as I said, if I were anti-autonomy I'd have to oppose an adult's ability to choose to be circumcised. Any person truly opposed to autonomy would, logically, have to oppose such an ability. And the part you overlooked in your description of autonomy is that these decisions are made within the limitations of their individual circumstances. For example, I'm tall and thin (that's my build), so if I wanted (heaven forbid) to look like Schwarzenegger, I'm out of luck. According to your argument I would lack "muscular autonomy", but that's not the case; it just means that some things are impossible. I still have the freedom to make choices that are realistic, thus I have autonomy.
Jakew April 21, 2011 at 07:51 AM
"Jake, can you do math? What is 710 times 100, divided by 5,206,295? I cheated, and used a calculator. That's right. No matter what Edgar Schoen says, by the Finns themselves, the percentage for 2002 was 0.013637337." -- first of all, you've conflated incidence and prevalence, and secondly you've even managed to miscalculate that. Let's start with the most obvious mistake you've made - the number of males in Finland, which won't be the same as the total population of Finland. As a rough back-of-the-envelope calculation, let's assume it'll be 50% of that, so that's 2,603,148. Now, the second mistake is to use an incidence figure as a prevalence estimate, which is nonsensical because the chances of circumcision are cumulative over a lifetime (the probability that an 11 year old is circumcised is the probability of him being circumcised in the last year plus the probability of him being circumcised in the year before that, and so on). It's hazardous to estimate prevalence from incidence, as the incidence can change over time, birth rates can and do vary over time, and so on. As a very rough estimate, we can multiply the incidence by the average male age (38.5 according to http://www.stat.fi/ajk/tiedotteet/v2007/tiedote_030_2007-12-04_en.html); this gives a figure of 1.05%. (continued)
Jakew April 21, 2011 at 08:00 AM
This is about a seventh of the figure cited by Houle and Schoen, but since they both cite the Finnish National Research and Development Center for Welfare and Health, which likely has actual prevalence statistics available, I'm more inclined to believe their figures. "The chances of all of these these things coming together, in the same person, at the same time, are stacked astronomically." -- not really, no, it's just the probability of you being wrong about four things. But obviously you're determined to reject that. "Truth be told, though, when someone tells me he's doing it for the children, and it causes them excruciating pain, I am forced to wonder, and even more so, when he's gay." -- that doesn't make any sense at all, sorry. "Do you have facts refute my numbers regarding European vs American HIV infection rates? Are you saying I should believe the epidemiologists over experience and reason + fact?" -- Most (though not all) European countries have lower rates of HIV than the US. No argument there. But I'm perplexed that you seem to think you can conclude something meaningful about circumcision rates from it, in spite of the fact that such a comparison cannot hope to isolate the effect of circumcision among other between-country differences. By (rough) analogy, it's like putting a few coins and some sand in each of a pair of bags, and then weighing them to estimate which has more coins.
Thomas Tobin April 21, 2011 at 12:24 PM
I'll cede you the population mistake, and accept your figure of 1.05%, though it seems very high to me, considering the last one I heard out of Finland was 0.09%. Then, I'll ask you why you are prone to accepting the figures from Houle and Schoen, when they are 7 times what you've worked out, and which are freely available on the net, coming from the Finnish health ministry I cited with a URI, and an open population census widely available. You are advocating circumcision. By being pro-parental choice, and taking it out of the medical realm, you are giving your stamp of approval, to people who circumcise so the kid can be like daddy, no matter what pain it causes them, and beyond all definitions of ethics - such as 'first, do no harm'. Have you viewed the videos on You Tube of unanesthetized circumcisions, with the sound up? That's what happens to many American babies when they are circumcised. But, it's OK with you, because it upholds a parental right, whether the baby is in agony or not. If you can't determine that circumcision is a medically effective procedure, then it should not be performed on people too young to give their consent. Despite all your clever argument, it really is as simple as that. Why should another person, no matter how well intentioned, decide whether we keep or lose half the skin on our genitals. We wouldn't stand for it if it was a female baby. Why does it make any more sense to do it to a male baby?
Jakew April 21, 2011 at 03:00 PM
"Then, I'll ask you why you are prone to accepting the figures from Houle and Schoen, when they are 7 times what you've worked out, and which are freely available on the net, coming from the Finnish health ministry I cited with a URI, and an open population census widely available." -- because, as I explained, estimating prevalence from incidence is inherently unreliable. The figure I've worked out is a very rough back-of-the-envelope calculation, based on the assumptions that the incidence remained constant over the past approx 40 years, and the birth and death rates were also constant over time. These aren't particularly solid assumptions; I just made them for convenience of calculation. As such, the figure could easily be wrong. As I said above, both Houle and Schoen cited the Finnish National Research and Development Center for Welfare and Health, which likely has actual prevalence statistics available, so their figures are more likely to be correct. "By being pro-parental choice, and taking it out of the medical realm, you are giving your stamp of approval, to people who circumcise so the kid can be like daddy, no matter what pain it causes them" -- you know I don't approve of circumcision without effective anaesthesia, Thomas. "If you can't determine that circumcision is a medically effective procedure, then it should not be performed on people too young to give their consent." -- you're free to hold that position, just as I'm free to disagree.
Thomas Tobin April 21, 2011 at 05:03 PM
Feel free to name another surgery which has not been proven medically effective, which is routinely performed on babies. Is there any other amputation you support on newborns?
Jakew April 21, 2011 at 05:11 PM
As I've said previously, I can't think of another surgery that has a similar risk-benefit balance to circumcision. Every other procedure that I can think of, in the absence of therapeutic indications, carries a net harm, and is therefore unethical to perform. If such a procedure existed, however, I would of course consider it acceptable.
Stan Barnes April 21, 2011 at 06:24 PM
I think most of the readers of this forum are not fooled by your sophistry.
Jakew April 21, 2011 at 06:29 PM
That seems to be your stock response whenever I make an irrefutable point, Stan. :-)
Thomas Tobin April 21, 2011 at 07:19 PM
Jake, why does the AMA, the AAP, the CPS, and the BMA disagree with your risk-benefit analysis? Wouldn't they know whether or not the benefits, if any, outweigh the risks? None of them is saying it does.
Jakew April 21, 2011 at 07:34 PM
"Jake, why does the AMA, the AAP, the CPS, and the BMA disagree with your risk-benefit analysis? Wouldn't they know whether or not the benefits, if any, outweigh the risks? None of them is saying it does." -- I'm not claiming that the benefits outweigh the risks, Thomas, so I'm a bit perplexed by your question. I'm saying that there's no net harm, in other words that the risks are not greater than the benefits (which means either that they're equal or that there is a net benefit - reasonable people disagree on that question). I'm saying that because there's no net harm, parental choice is justified and appropriate. And I can't see any contradiction between that statement and the policies of these organisations; after all these organisations more or less say the same thing.
Thomas Tobin April 21, 2011 at 07:42 PM
Reasonable people do NOT agree that there is no harm from circumcision. You simply choose to look the other way. MRSA infection, exsanguination, excessive bleeding, painful erection, hidden penis, skin bridges, meatal stenosis, not to mention the loss of the foreskin itself, which makes entry comfortable for most people. No medical society says the benefits equal the risks. They say the risks outweigh the benefits. No net harm? Why does it leave a scar? Given a choice, would you chose to have 100% of the skin of your penis, or 50%? Never mind, I forgot who I was talking to.
Jakew April 21, 2011 at 07:49 PM
"MRSA infection, exsanguination, excessive bleeding, painful erection, hidden penis, skin bridges, meatal stenosis" -- yes, these are risks, to be weighed against the benefits. It's not clear why you're listing them again: do you think that listing these, but not benefits, causes the evidence to be weighted against circumcision? "not to mention the loss of the foreskin itself, which makes entry comfortable for most people." -- serious evidence would be interesting. "No medical society says the benefits equal the risks." Yes, they do. The CPS, for example: "The overall evidence of the benefits and harms of circumcision is so EVENLY BALANCED that it does not support recommending circumcision as a routine procedure for newborns." (emph added) http://www.cps.ca/english/statements/fn/fn96-01.htm
Stan Barnes April 21, 2011 at 08:25 PM
Jake: "I'm saying that there's no net harm" The only person who can legitimately say whether or not cutting off a normal, healthy part of HIS penis without his consent and without a compelling medical reason is the man himself.
Stan Barnes April 21, 2011 at 08:41 PM
If there is NO compelling medical reason for the surgery, it is unethical for a doctor to cut off a normal, healthy part of my body without my consent. There is NO compelling medical reason to cut off a normal part of a healthy boy's penis.
John Kuehne May 05, 2011 at 09:26 PM
Jake always claims to be "pro parental choice" to maintain the appearance of neutrality he needs to control all Wikipedia articles on circumcision and foreskin, and he trolls for sites like this. Jake is a frequent poster and supporter in "mandatorycircumcision.blogspot.com", where he also maintains this rhetorical ruse of neutrality, while in every other way pushing circumcision. Jake decided to get circumcised as an adult as his gay sexual preference, not medical, but on the Internet he pushes medical reasons. But what about the sexual preference of boys who were not given that choice? Jake loves to argue on his grounds - medical grounds - but he withers on other fronts, e.g. http://www.rollingdoughnut.com/cgi-bin/mt/mt-search.cgi?IncludeBlogs=2&search=circumcision
John Kuehne May 05, 2011 at 10:01 PM
Now to answer the question that Jake cannot answer, i.e. "What was the deciding factor in your decision to either circumcise or not circumcise your son?" That's easy. I didn't amputate sexual tissue from my son, and I only had to look at the mishmash of scar tissue on my own penis to come to that decision. On my penis, an extensive amount of skin was cut, and the inner and outer skin were mashed together, leaving a horrific mosaic held together by scar tissue. I've always known something was wrong, but without any comparison I really couldn't imagine how it got that way, and I just had to assume it was this way for all men. The internet changed that: now I can see for myself in photographs that circumcision injuries are pretty common, and don't get counted as "complications" by doctors. I did not consent to the amputation of sexual tissue from my body, and the mess it left makes me furious. This is something that circumcision advocates like Jake who got cut as an adult on sexual whim simply can never understand. Nor can his hyper-medical sophistry of "net harm" ever explain to me or other men harmed by circumcision why my penis was so badly damaged. When my son was born, our doctor and a hospital nurse repeatedly hassled us to have him cut. I can still remember the disingenuous smile as he insisted on circumcising my son, and the flash of anger on the nurses' face when I said "no, I don't want that." For the record, we didn't have our daughters cut either.

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