the controversy

I've been on my obstetrics rotation. I love it. The intern with whom I am working is pretty nice and cooperative. The ever popular hot topic of circumcision comes up a lot with him. We have discussed it. I feel that I am fairly tolerant of others' different perspectives. Clearly, I cannot argue that all newborn males be circumcised compulsively and routinely as if it were an immunization (though I have some misgivings about compulsively doing even that). The act is ethically similar to both vaccination and also to tattooing or piercing, however.
There are many arguments that opponents of neonatal circumcision employ. However, many of the opponents are not content to just not circumcise their own children. They often argue that the procedure not be offered at all; not be covered by insurance; or, as in San Francisco in recent years, even lobby that it be legally banned. Opponents condemn the process as some form of medically unnecessary painful mutilation. They suggest that the preference among women for the circumcised penis is socially biased and that any self-consciousness that the boy has about being uncircumcised is only because of the fair-weather fashion trends of our times. It has been proposed that the autonomy of the child is threatened by the will of the parents. They argue that any benefit that the procedure might convey could easily be achieved with good hygiene and safe sexual practices and that the problems that having a foreskin may actually cause are so rare that they can be ignored. They sometimes argue that it is cosmetic in nature and compare it to female genital mutilation, which is not practiced in the United States and is not taught to medical students or offered in American hospitals. Female circumcision can mean a lot of things, however, and seldom is analogous to the male circumcision.
But, why do Westerners circumcise despite the negative media? Some, like me, belong to a culture that routinely circumcises male infants. For Jews, it is considered to be a covenant with G-d. It represents our faith. Parents who choose circumcision join thousands of years worth of parents who also put faith in the fact that circumcision is beneficial. They performed the procedure without their children's consent, often in defiance of the majority culture and opinion, and it made them cry and the baby cried and was sore for a week. Most boys who have undergone the <40 minute procedure have uneventful urogenital childhoods with respect to infections and physical trauma. They have fewer UTIs and yeast infections. If, in the "intact" boy the foreskin is not retracted regularly by a certain age and after it may be unable to retract beyond the glans and on occasion can become stuck behind- which is quite dangerous. It is actually dangerous for the child not to masturbate if uncircumcised, but serious phimosis is still relatively rare. Irritation of the glans, however, is not uncommon in uncircumcised boys. An accumulation of smegma and microorganisms may be a gift to the uncircumcised boy's first sexual conquest. May she be pure and virtuous or else, he may also be carrying away a foreskin full of chlamydia or syphilis. The foreskin adds infect-able surface area and provides environmental protection for microorganisms and viruses. Circumcised boys have lower rates of several STIs, both contracted and transmitted and; as a consequence have way fewer cases of penile cancers and partners plagued by GU complaints. It seems that even our ancestors recognized these problems enough to try to prevent them.
Neonatal circumcision was of limited risk even four thousand years ago and now is done under local anesthesia so pain is significantly reduced. In the early 1900's the US took on circumcision for non-religious reasons, as a plot to end masturbation in children, an utter failure. While uncircumcised boys must retract their foreskins in order to clean beneath them, removal of the skin doesn't necessarily dissuade them from touching or playing with the penis! However, circumcision may increase time from erection to orgasm during sex, therefore allowing the partner to reach climax prior to a her partner's orgasm. There is much anecdotal evidence that the friction of the foreskin against the glans in the intact male can lead to over-stimulation and premature ejaculation. Why do women prefer circumcised?
But, as for autonomy... We are a civilized country. Shouldn't we get permission from the child first? If as an an adult, he wants it done or if he needs it done for some medical reason, he can do it. Right? This thinking, disregards the expense, trauma, and associated healing time of doing the procedure later in childhood or in adulthood. It also may not convey as much benefit if the man is already sexually active. Also, speaking from a purely anecdotal standpoint, few circumcised men are dissatisfied that the procedure was performed in infancy. There are much more uncircumcised men who feel embarrassment about their extra skin.
I was recently out in the YK Delta where there is a low incidence of neonatal circumcision and a high incidence of pelvic inflammatory disease. Hygiene is poor and some of the people don't even change their underwear regularly. They don't have indoor plumbing. Everything is expensive, if available at all. Winters are long. It is unreasonable to think that sex won't happen and that people will always have access to sanitation and medicine. The truth is that we cannot predict what our child will be exposed to and that is why we vaccinate and that is why I believe in parents' right to choose circumcision. It is a small procedure that can improve the child's health and overall quality of life and improve public health.