The Circumcision Debate: A Brief History

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Routine circumcision of baby boys for nonreligious reasons is not common today in any country other than the U.S.

On his eighth day of life, a newborn Jewish boy is taken to his family’s synagogue. His mother hands him to the kvatters, who place him in the Chair of Elijah for his bris. So begins the Jewish ritual of circumcision, which tradition says seals Abraham’s covenant with God as described in Genesis 17.

A Muslim family teaches their sons that the Prophet Muhammad was born without a foreskin. To emulate the prophet, Muslim boys are circumcised, usually in a hospital, sometime before the age of 12.

People of many cultures and religions, including Jews, Muslims, ancient Egyptians and tribal people around the world, have practiced male circumcision for centuries. No one knows for sure exactly when it started, but some historians say it may have begun as a puberty rite among Australian aboriginal tribes in 10,000 BC. Later, tribes in Northern East Africa and the Arabian Peninsula would adopt the practice as well.

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Circumcision has fallen in and out of favor throughout history, but the story of its introduction to nonreligious, Western populations is interesting. Outside of Jewish and Muslim communities, it was uncommon to routinely circumcise boys until the late 19th and early 20th centuries, when doctors began promoting it as a way to prevent masturbation and some diseases.

Led by Dr. John Harvey Kellogg and Dr. Lewis A. Sayre, a group of American doctors claimed that surgical removal of the foreskin would cause pain to the genitals, which they hypothesized would discourage boys from wanting to touch their penises. Some doctors claimed it could prevent polio, epilepsy and diarrhea too.

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Routine circumcision of baby boys for nonreligious reasons is not common today in any country other than the U.S. Even here, there is a great deal of controversy surrounding the practice. Some parent groups vehemently oppose circumcision and call it mutilation. They say that it’s medically unnecessary and painful. Georganne Chapin, executive director of Intact America, an anti-circumcision advocacy group, says that it is unethical to remove a healthy body part, such as the foreskin, when there is no medical reason to do so. “A healthy foreskin is no more a threat to your son than the hymen is to your daughter. There is no good reason for parents to have this healthy body part surgically removed from a baby who is too young to consent.”

Opposition to circumcision is so strong in some parts of the world, including parts of the U.S., that a number of governments have attempted to outlaw it. In 2011 ballot initiatives in San Francisco and Santa Monica, California, attempted to ban circumcision in males under 18, but they were struck down by the courts. In Australia medically unnecessary circumcision is not allowed in public hospitals, though it is still legal to do it privately. In South Africa it is illegal to circumcise a boy under 16 years old except for religious or medical reasons. And today Iceland is considering a bill that would outlaw removing a child’s foreskin for nonmedical reasons.

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Some doctors say that circumcision can be useful in the prevention of certain infectious diseases. A number of studies conducted in sub-Saharan Africa found that circumcision greatly reduces the risk of HIV infection in heterosexual men. In response to these studies, the American Academy of Pediatrics (AAP) decided to weigh in on the debate.

In a 2012 policy statement, the AAP found that “…preventive health benefits of elective circumcision of male newborns outweigh the risks of the procedure.” The health benefits cited in the report included a slightly reduced risk (about 1%) of urinary tract infections (UTIs) during the first year of life, lower risk of HIV and other STDs, and lower risk of penile cancer.

According to the AAP, the risks of circumcision were more difficult to define. Dr. Douglas Diekema is a pediatrician with the Treuman Katz Center for Pediatric Bioethics at the Seattle Children’s Research Institute and a coauthor of the AAP Policy Statement. Diekema says, “There are risks, but the incidence of serious adverse events is very low when performed by an experienced practitioner using sterile technique. The most common complications are minor and include bleeding, which stops with a few minutes of applied pressure, and minor skin infections.”

The AAP stopped short of recommending routine circumcision, stating that the “health benefits are not great enough to recommend routine circumcision for all male newborns, [but] the benefits of circumcision are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns.” Still, a lot of people took this to mean that the pediatricians’ group was supporting circumcision.

Doctors and advocates around the world reacted to the policy statement with shock and anger. A group of pediatricians from Europe, Canada and Australia wrote an article for the AAP’s journal Pediatrics alleging that the AAP’s conclusions regarding circumcision were culturally biased and based on a preference for circumcision in the U.S. They point out that most of the diseases that AAP claims circumcision can prevent are either extremely rare or much more efficiently prevented in a less invasive way.

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For example, circumcision does reduce the risk of HIV and other STD infection among heterosexual men in some African countries, but it is extremely rare for heterosexual men to contract these infections from female sex partners in the U.S. Here, the most common modes of transmission are homosexual intercourse and injection drug use. Also, condom use is nearly 100% effective in preventing HIV and other STDs, and it doesn’t require the removal of any body parts. The AAP report also cites a reduced risk of penile cancer and UTIs in circumcised boys. But these doctors say that penile cancer is exceedingly rare, and UTIs are not common enough to justify invasive preventive surgery, especially since they are treatable with antibiotics.

All this medical back and forth may be moot, though. Most parents who circumcise their sons are not thinking of medical justifications. For many Americans, it really is a cultural decision. Some say they feel that circumcised penises are more attractive. Some simply want their sons to look like all the other boys. And many parents do it simply because they assume it’s a universal procedure.

A mother in Bowie, Maryland, says, “I had all three of my sons circumcised, just because it seemed like the thing to do. My husband was circumcised and I believe he was in favor of it and I just went with it, never doing any research or speaking with a doctor. I never questioned it.”

She adds that she has since had her doubts about that decision. “After [my son] was born, I became acquainted with people who were against it and learned about the arguments against it. If I had any more boys, I don’t believe I would have them circumcised now.”

For other parents, it is a hygiene issue. “I did it for my daughters-in-law,” says a mother in Stevensville, Maryland. “My mom told me when I was pregnant that my dad was uncircumcised and it would cause her issues occasionally, as even a fastidious daily cleaning would still allow bacteria to thrive under the foreskin.”

Whatever the reason, unless advocates succeed in their attempts to ban it, the decision to circumcise or not is ultimately up to the child’s parents. It is important for parents to understand all of the facts surrounding circumcision so that they can make an informed choice. end

 

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