Circumcision not indicated

ust a Simple Snip? Why I Don’t Recommend Circumcision by Paul Thomas, MD, pediatrician

When my first son was born in 1987, the American Academy of Pediatrics task force stated there was no medical
indication for routine circumcision. I was a new pediatrician, board eligible but not yet board certified. I felt I needed to
follow academy guidelines, so my son was not circumcised. That was a hard decision for me: I was circumcised and I
had a nagging feeling that it was important for my son to look like me.

By the time my second son was born in 1993, the AAP had revised its position, stating there were potential medical
benefits. We chose to leave him intact anyway. Same for son number three, who came along in 1996. My wife and I
figured it would be best for our boys to look the same.

In 2012 the AAP came out with yet another statement about circumcision, a contradictory report that does not
explicitly recommend routine circumcision but states that the benefits outweigh the harms and implies insurance
companies should pay for it.

“After a comprehensive review of the scientific evidence, the American Academy of Pediatrics found the health
benefits of newborn male circumcision outweigh the risks, but the benefits are not great enough to recommend
universal newborn circumcision.”

How is a parent to make sense of that?

The benefits identified by the AAP task force include the reduction of risk of urinary tract infections as well as of
sexually transmitted diseases in circumcised boys. But urinary tract infections in boys are exceedingly rare to begin
with, so this benefit is misleading. The most effective way to stop the spread of sexually transmitted diseases is to
practice safe sex. Critics of the AAP report also say the studies linking lower STD rates to circumcision, which were
conducted in Africa, are deeply flawed. They point out that European countries with the lowest rates of sexually
transmitted diseases have the highest numbers of uncircumcised men.

Some circumcised men believe their sons should be circumcised simply because they were. Certain Jewish, Christian,
and Muslim communities consider it an important religious practice. While I remain respectful of everyone’s religion
and traditions, I would ask you to think long and hard about this choice. Circumcision is a cosmetic procedure that
permanently alters a boy’s body, removing an essential and integral part of the penis. The foreskin protects the head
of the penis from injury. It is made up of highly erogenous tissue, which makes intercourse more pleasurable for the
man and more lubricated for his partner.

If you were an uncircumcised adult, would you choose circumcision for yourself? The answer my five boys give is a
resounding “No way!” One of my sons gets so angry when this topic comes up that he will stand up, raise his voice,
and rattle off a long diatribe of how insane it is—barbaric, inhumane, and brutal—with the passion of one about to
lose his entire manhood! He equates circumcision with child abuse and circumcision is considered “genital mutilation”
by the World Health Organization, even when it involves only a nick to the genitals. Yet infant male circumcision is
considered “routine.”

The CDC estimates that the circumcision rate in America fell from a high of 65 percent of boys born in hospitals in
1979 to 58 percent in 2010. The rate has dropped more in recent years, but just slightly. These days only a little more
than half of newborn boys are circumcised within the first hours or days of their lives. Worldwide, the majority of men
are not circumcised. When England changed to universal health coverage after World War II, its circumcision rate
declined sharply. Now less than 5 percent of men in the United Kingdom are circumcised for medical reasons, and
circumcision rates are as low as 1 percent in Scandinavia.

Not a single medical association in Europe recommends routine male circumcision. The Royal Dutch Medical
Association has urged a ban on the procedure in Holland as it can endanger a baby’s health and is ethically
questionable. In the words of one law professor writing in The New York Times, “All human beings should be able to
make their own decisions about whether their genitals are to be injured. All the more so if such a procedure is
irreversible and not medically necessary.”

Will a baby with an intact penis have problems related to it? Most likely not (and any problems are easily treatable),
unless his doctor creates them! American doctors have unwittingly caused and continue to cause damage to
uncircumcised penises, one of the most embarrassingly misunderstood topics in American pediatrics. In the past
doctors recommended that parents retract the newborn’s foreskin and wash under it. This is absolutely the wrong
thing to do! How do you care for a newborn’s penis? You simply leave it alone! The foreskin naturally retracts by the
time a boy has gone through puberty. It may retract before that on its own, and it may not. Baby boys often tug on
their penises. This is normal and even helpful and should not be discouraged. But never let any doctor forcibly retract
your son’s foreskin. Forcible retraction can do untold damage, often causing tears that heal by scarring, which causes
adhesions that may need to be surgically corrected.

If you have cared for a recently circumcised boy, you may have seen firsthand how circumcision can cause post-
traumatic stress in an infant. If the baby cries every time you change his diaper, it may be because his penis is
swollen and raw from the circumcision or from the stress caused by the pain he experienced during the operation.
Though doctors are advised to use anesthesia, some prefer not to. Others do not wait long enough for the penile
block to take effect. The operation is painful and it is common to hear a baby screaming during it, even when
anesthesia is used correctly. So a newborn makes this association: When my diaper is taken off, something bad
happens down there.

A recent study of more than 340,000 boys from Denmark showed that those who were circumcised had an 80 percent
increase in infantile autism.  But how can circumcision lead to autism? you might ask.  I wondered the same thing.  
Perhaps babkes who are circumcised are given acetaminophen-containing pain relievers, which can cause cell death
in the presence of testosterone.  For more on acetaminophen, see Chaper 1.  Or perhaps the stress a newborn
experiences while being circumcised alters his brain development.  Stress is correlated with poor brain development.

I used to be neutral about circumcision.  I would talk to families in my practice openly and tell them that I am
circumcised but my sons are not, that my boys are grateful to us for leaving them intact.  I would tell them that I am
glad we did not alter their penises, and that I do not recommend circumcision.  But I would always add it is ultimately
the parent's choice.