Friday, June 10, 2011

Something more about circumcision

Found via Reddit, a nice summary:
The American Academy of Pediatrics has stated that “Routine circumcision is not necessary”. Whether done by a physician in the hospital, or a mohel in a ritual brit milah, the procedure has significant complication rates of infection, hemorrhage and even death. Mortality may actually be higher than thought since some of these deaths have not been attributed to circumcision, but listed only under their secondary causes, such as hemorrhage or infection. I’ve learned of the very important role the foreskin has in the protection of the head of the penis in the infant, and in sexual functioning in adulthood. It has also been shown that the newborn feels pain even more acutely than adults do, and that many of the infants who stop crying during circumcision are actually in a state of traumatic shock. To my amazement I learned that the USA is now the only country in the world routinely circumcising babies for non-religious reasons.
Via the comments a link about complications and via some googling a study about circumcision related deaths:

In summary: through a thorough review of the literature and the application of common-sense calculations, this study has arrived at a reasoned estimate of circumcision-related neonatal deaths in the United States: approximately 117 per year.


Physicians are less likely to circumcise their sons than the general populace (Topp, 1978), suggesting that they know it is an unnecessary surgery, but don't relay this valuable information to parents. Many physicians say that they prefer not to perform circumcisions, but do them anyway, rationalizing that the boy will be in better hands with them than with a physician they might refer the parents to. This may seem a noble position at first, but there can be no pretending to be a conscientious objector to circumcision while simultaneously performing one.

Circumcision is a $2 billion healthcare market, which includes costs for the procedure itself, dealing with complications, and payment for repairs (Fauntleroy, 2001). A study of Medicaid records found that a greater number of circumcisions are performed in states where Medicaid pays more for the procedure (Craig & Bollinger, 2006). A busy delivery-room obstetrician will do as many as five circumcisions a week. Physician reimbursement is at about $167 each6 (Van Howe, 2004), which means that they can potentially make an extra $3 ,340 per month, or $40 ,080 per year. That is more than an entire year's income for 45% of Americans (US Census Bureau, 2005). One physician brazenly admitted, "I love doing circumcisions- they make my Mercedes payments!"7


Risk assessment for an unnecessary surgery must be held to a higher standard than that for a life-saving surgery. We accept that a heart transplant carries with it a substantial risk of death, but without it there is a certainty of death. On the other hand, the risk from circumcision, which has no therapeutic value, needs to be zero for the infant's sake, all the more so because he is never consulted about whether he wishes to take his chances.

We hear very little in the media about circumcision-related deaths compared with other causes. For instance, compare the 1 17 annual deaths from circumcision with those from other causes for male infants: suffocation (44), mother's use of addictive drugs (27), HTV/ATDS (19), homicide (17), automobile accidents (8), drowning (2), and falls (1) (CDC, 2004). Sudden infant-death syndrome (SIDS) killed 1 ,216 boys under the age of one year in 2004; of those, 115 were under the age of 1 month (CDC), which is the same risk as from circumcision. Approximately 36 teen-aged boys are killed in schoolyard shootings each year (Donohue, Schiraldi, & Ziedenberg, 1998). But there is more publicity for the SIDS deaths and shootings than for the circumcision-related deaths.


If a similar number of children were dying from another optional body modification-say, tattooing or piercing- would the public be outraged at the people and institutions benefiting financially? If not, is it then due to gender bias? Imagine the uproar if a hundred girls were dying from female circumcision each year. Why are so many adults silent about this atrocity? Adults would be furious and highly vocal, to say the least, if someone were to forcibly cut their genitals.


It is reasonable to conclude that about 117 circumcision-related deaths occur each year in the United States- approximately 1 out of every 77 male neonatal deaths- and that thousands of boys have died since this practice was first medicalized 160 years ago. These boys died because physicians have been either complicit or duplicitous, and because parents ignorantly said "Yes," or lacked the courage to say "No." Every one of these boys would have had a chance at life had he not been circumcised. Circumcision can no longer be called either a beneficial surgery or a beneficent rite of passage, but by its true designation: an unrecognized sacrifice of innocents.

And another one:
Today the main argument against the foreskin is its supposed correlation to sexually transmitted disease, especially AIDS. And especially AIDS in Africa.

With American funding, thousands of adult African males have recently undergone circumcision to study their subsequent HIV infection rates compared with those of uncircumcised counterparts. HIV infection rates among uncircumcised control groups (often before studies had run their course) led researchers to conclude that the foreskin significantly contributes to seroconversion.

There is ample cause to question this conclusion.

First, a hard reckoning: Several African countries with some of the highest rates of HIV/AIDS in the world (Nigeria, Ethiopia, the Ivory Coast, Gabon) already circumcise at rates exceeding that of the United States.

Moreover, efforts to export American genital norms expose a glaring hypocrisy: The United States has both the highest HIV infection rate and the highest circumcision rate of any industrialized nation. By comparison, Australia, New Zealand and the Netherlands could take a more plausible "intactivist" stance. Their predominantly uncircumcised men have some of the world's lowest HIV infection rates.

Many developing countries, such as India, Thailand and Brazil, have successfully combated AIDS not through circumcision but through aggressive health- and condom-education programs. While hardly rid of HIV, these nations have dodged the devastating mortality rates of, say, Uganda or Botswana.


Ironically, all arguments for prophylactic circumcision as a successful harm-reduction strategy may be built on a fundamental diagnostic flaw. Existing scientific data demonstrate that adult circumcision typically causes a marked overall decrease in sexual pleasure and erectile function. Statistics citing circumcision's efficacy against HIV may not reflect the foreskin's contribution to infection so much as demonstrate its contribution to sexual performance—and the potential risks therein. (Chalk one up for the Victorians.)

Confronted with complex, real-world dynamics, the limited scope of circumcision research may not help to stem HIV infection rates at all, but may actually sustain or even accelerate them. The president of Uganda and the Brazilian secretary of health have already reached this conclusion, denouncing recommendations for adult circumcision in their respective countries.

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