History of Circumcision

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US Doctor: No need to circumcise most boys

The following article by Dr Roxanne Allegretti was published in the Freelance Star, Fredericksburg, Virginia, USA, in November last year. It shows that even in the USA, where circumcision of baby boys is still common, doctors are very critical of the custom and recommend that boys be left as nature made them.

American doctor says routine circumcision of baby boys is wrong

FOR THOSE OF YOU who read my last column and the letters to the editor that followed, you already know that my comments about anti-circumcision demonstrators at the recent American Academy of Pediatrics meeting in Washington D.C. were not well received.

My column was about SIDS prevention, but I slipped in a little joke about the demonstrators being mostly “graying hippies” and having bumper stickers like, “Not Circumcised? You Lucky Stiff!” While I was trying to be funny, and make light of the controversy at our conference, I apparently offended people all over the U.S.A. and Canada. And all this for a column that wasn’t even about circumcision. Obviously, people feel very strongly about this issue. The funny thing is, I agree with the demonstrators. I don’t think circumcision should be routinely performed on newborns.

I don’t do circumcisions. I was trained to, and had to do them while still in the Navy. But in our area, unlike where I trained in California, Ob/Gyn doctors perform most circumcisions. Even if they didn’t, I still would not perform them.

Like the demonstrators, I believe that removing a healthy body part for cosmetic reasons is not appropriate. Well, let me rephrase that, because I have no problem at all with liposuction in a consenting adult. But in most cases of neonatal circumcision, we’re talking about a helpless newborn losing a very sensitive part of the body for no good medical reason. Certainly there are religious reasons for some families -- more on that later.

In the U.S.A., most people who choose to circumcise their newborns do because they think that that the penis looks “normal” that way and so that it will be cleaner. Neither of these reasons is valid. Isn’t the “normal” penis the one that God created? Whatever happened to, “If it ain’t broke, don’t fix it?” In fact, 80 percent to 85 percent of the world’s male population is not circumcised. So that is more “normal.”

I hear fathers say they worry that if their son does not have it done, he’ll wonder why he doesn’t look like his dad. Well, that is just as easy to explain as questions like, “Dad, why do you have hair there and I don’t?” Or, “Dad, why do you have blue eyes and I have brown eyes?”

Hygiene is also a non-issue for most people. There are rare cases, like soldiers out in the field for days and days without bathing, in which the uncircumcised penis is more prone to infection. [Ed: Unlikely – see The Sand Myth.] But in most cases, boys who are “uncut” learn to care for their penises just like they learn to brush and floss their teeth, and it’s no big deal.

Let me mention that there are religious reasons for circumcision in the Jewish and Islamic faiths. I consider that to be very different than the routine circumcision done just because everybody else is doing it. In the Old Testament, circumcision is described as a symbolic act by which a Jewish male enters into a covenant with God. This is a long-standing tradition, and the bris ceremony is very important in the Jewish faith. However, I have learned that the practice is beginning to be questioned by many Jews (See Jewish Circumcision Resource Centre).

It is unclear why Christians in Britain and the USA took up the practice, or why it occurs more in the U.S.A. than any other country in the world. There are Christian organizations such as Catholics Against Circumcision which state that the New Testament has passages that recommend against the practice.

Several resources I read mentioned that the practice became more widespread in the late nineteenth century in the U.S.A., and was touted as a way to cure masturbation (which was thought at the time to cause insanity, blindness and all sorts of horrible things). The circumcised penis is certainly less sensitive, due to the loss of a ring of tissue near the tip of the foreskin, which is the most sensitive part of the penis. But, I’m not really seeing that this was a cure

Anyway, routine circumcision goes on in many areas, despite the fact that the American Academy of Pediatrics, American Academy of Family Practitioners, and the American Medical Association have all published statements that do not support routine neonatal circumcision. These are echoed by medical organizations all over the world, including the Australian Association of Paediatric Surgeons, which put it like this: “We do not support the removal of a normal part of the body, unless there are definite indications to justify the complications and risks which may arise.”

As the American Academy of Pediatrics notes in its position statement, there are potential medical benefits, but they are minimal and do not outweigh the risks. (You can read the statement online.)

There are definitely fewer urinary tract infections in male infants under 1 year of age who are circumcised. However, fewer than 1 percent of uncircumcised baby boys get UTIs, so the increased risk is still pretty minimal. The same goes for the increased risk of penile cancer in uncircumcised men. There is a slightly increased risk, but this cancer is quite rare. [Ed: The risk is increased only if hygiene is badly negected and phimosis is present.]

Potential complications of circumcision are more likely and include bleeding, poor cosmetic results, adhesions (I see a lot of those), scarring of the urethral opening, infection, and very rarely, penile amputation or death.

Then there is another issue I never thought about until I started researching this article. In the U.S.A., 1.2 million circumcisions are performed each year, yet this is considered a medically unnecessary procedure. The cost adds up to somewhere between $150 million to $270 million per year. Just think of how that money could be better spent!

In Virginia, Medicaid still pays for circumcisions. If that money was saved, it could pay for many of the infant’s immunizations, for example. Several states, including California, Arizona, Florida, Washington and Oregon, already have disallowed Medicaid coverage of circumcision.

Having to pay $100 upfront to be circumcised was certainly a big deterrent at my last practice in California. In California, circumcision is in the minority -- approximately 33 percent of newborns are having it done. In Virginia, it is still more widespread than that, but seems to be decreasing in popularity. (Exact numbers are difficult to come by, but I think we are in the range of 75 percent).

It seems like I end almost every column this way: Be informed. Know the risks and benefits before you decide. If you choose to have the surgery performed on your newborn, be sure that analgesia is used. Lidocaine injected into the base of the penis is very helpful in reducing pain during the procedure. Also, giving the baby sugar on a pacifier decreases their pain response. Hard to believe, but even a few years ago it was routine practice not to use any analgesia or anesthesia for newborns being circumcised. Now, it’s considered the standard of care.

[Ed: It is difficult to avoid the pain, since it is not safe to give babies effective anaesthetics. Pain control is far easier in adults, as they can be given general anaesthetics and effective painkillers after the surgery. Further information here.]

If you choose not to circumcise your son, you don’t need to do anything special to care for the penis -- just normal bathing. Do not try to retract the foreskin! This should not be done until years later, and will happen naturally with time.

For more information on care of the intact penis, see

Nocirc USA

Circumcision Information and Resource Pages

Doctors Opposing Circumcision

Dr Roxanne Allegretti welcomes reader comments and questions. Write to her at
Free Lance Star
616 Amelia St
Fredericksburg, Virginia, 22401
USA
email: newsroom@freelancestar.com.

Free Lance Star

Fredericksburg, Virginia, USA
13 November 2005

Other American doctors agree with Dr Allegretti

The following rather forthright letter was sent by Dr Chris Fletcher, a doctor in Santa Fe, New Mexico, to parents who sent him the following inquiry:

Dr. Fletcher,

My wife Lycia is the daughter of Tom and Julie …, who are friends of yours, I believe. They mentioned that you are a strong opponent of circumcision. We have a baby boy due at the end of March and are debating that very issue.

If you have a minute or two, would you mind giving us your arguments?

Thanks very much in advance.

Regards,

Eric …
Portland, OR

Dr Fletcher replied:

The issues regarding circumcision are both quite simple (just leave it alone) and very complex (why do American parents persist in “needing it”, since it is basically a rare or unknown procedure most other places in the world). I would be happy, in order to save your son’s natural or God-given genitals from a mutilator and real/potentially nasty side-effects, to spend a lot of time discussing this. In fact, when I got Tom and Julie’s Xmas card mentioning that Lycia was pregnant and expecting in March (and a boy at that) I actually wondered whether circumcision would be an issue, and whether someone might contact me. Washington and Oregon states wisely restricted Medicaid monies, along with many other Western states (and a total of 16 at present), for unnecessary procedures, including newborn male genital mutilation (circumcision), so the kids from poorer families actually now get a better deal than the ones with private insurance!

First, pick up the latest issue (September-October) of Mothering Magazine -- two good articles, one by a mother of an intact 3 year old boy who very simply and persuasively argues the case against it, and the other, an article on legal issues which is partly an interview conducted by a reporter with me as the reportee.

I am attaching a paper which I presented at Oxford several years ago exploring the issues of what American doctors actually tell their patients, charge, do for their own sons, believe, etc. That paper makes up part of the above article in Mothering.

Then I would go to the best all-inclusive website (CIRP.org) which has everything you would ever need to really understand the issues, the cons and whatever pros people have dreamed up, and which has won many important national and international awards for websites.

After that, if you have any lingering issues or doubts, call me or email me again. Believe me, it is only a prowess and money issue for doctors. Only child molesters, perverts, or really uneducated physicians would in any way argue that it is a good thing. Still the two most common arguments are the 1950s one -- ”Isn’t it cleaner doctor?” -- what we call the cleaner wiener argument. And “I want my son to look like me”. Both are really stupid and simplistic when you think about it: how can a cut/wounded/mutilated tissue be cleaner than the one all baby boys are born with, especially when you put the bleeding and now smaller penis stump in a diaper (full of clean things like urine and stool). What if your son has different eye color or looks like his mother or has dark hair instead of blond, etc... ? Do you remove eyes and put different colored ones in? Do fathers and their sons ever actually stand side by side (when they are old enough to speak and think rationally!), and compare their penises? Mine never did -- not my father, not my brothers, not my friends in the locker rooms, and not my own sons. (I ran track and was a swimming champion, so I have been around a lot of naked guys.)

When I moved from Massachusetts in 1981, I was fully prepared, as trained, to continue mutilating little baby boys, but I was given articles at my clinic in Santa Fe which immediately made me seriously question what I was doing. Giving up a procedure which I thought I had learned as part of my fine training was an ego issue; the money was not, since I had never been paid for doing circs as a resident.

Circumcision is not simply a little snip, but a major and brutal surgery on the most sensitive part of a male’s anatomy, with lifetime consequences for all cut boys. Erectile dysfunction, increased infections in boys, such as multi-antibiotic resistant staphylococcus aureus (MRSA), lack of sensitivity, etc. The Lauman lifestyle study (University of Chicago) mentioned in the first Mothering article was fascinating since it showed that circumcised men were more likely than uncircumcised (entire) men to need anal and oral sex, girlie magazines, X-rated movies, prostitutes, sex toys, masturbation, and were more likely to get syphilis and chlamydia, all simply the end results of seeking out avenues for stimulation because of the decreased functionality from lacking a foreskin and from the scarring caused by the mutilation itself.

I prescribe many times more Viagra, Cialis, etc. for circumcised guys than normal men. Circumcision prevents no disease, and does not improve anyone, except perhaps certain Hasidic Jews (see today’s New York Times) who mistakenly believe that God commanded them (and no other Jews, of course) to perform a certain weird type of circumcision in which the boy’s penis needs to be sucked clean of blood by the circumciser. Several babies have recently died from herpes communicated by this unhygienic practice. In the 19th century this practice was banned in New York and many other places because of transmission of syphilis, tuberculosis and other diseases.

Anyway, my two sons were left intact, and are quite pleased that they were not cut. The older one (Lycia remembers Christopher) is now 23, and when he was a college student won an international essay contest questioning the ethics of circumcision. The younger one, Benjamin, now in college, surprisingly, wrote a similarly powerful paper on it in prep school.

So I have attached my paper and two graphs which are part of it, a listing of the crazy justifications for circumcision given in the US over the last century, and the legal definition of surgery. I suppose you are not in the medical field, so for someone like me to load you up with this might seem weird. I know I felt that way when my assumptions and lack of knowledge were first challenged. Now it seems so normal not to cut, and so perverted and wrong medically, ethically, and legally to allow circumcision, and so right and honest to help parents make the correct and caring decision for their son.

Hello to Lycia ...

Christopher Fletcher MD