Some snippets on infant circumcision
There were a couple of mentions of circumcision in the blogosphere today, and it seems the commenters have come out of the woodwork on this issue. Tantalus Prime posts about a child who died after a routine circumcision gone wrong (eek, here in Ontario, too), and uses that as a springboard to lament the high rates of circumcision despite underwhelming medical indications. (via Pharyngula). On the other hand, #1 Dinosaur just ranted about how terrible it is that circumcision rates are falling in the US. (hat tip to Kevin, M.D.)
There’s been a lot of back and forth on this issue, and opinions can range from people saying snipping the foreskin off is the cure for AIDS to those who curse it as the equivalent to female genital mutilation and it should be banned. This has been fueled by recent studies in Africa which showed some benefit to having a circumcised penis to lowering HIV transmission rates; another recent study in the British Journal of Urology did some objective studies of sensitivity in penises and found that circumscised ones are less sensitive (not that that is a surprise — its clinical relevance of course is debatable).
In my mind, the benefits are certainly limited. Any medical benefit (e.g. reduction of UTIs, HPV, penile cancer, HIV) is in the first place small — remember relative vs. absolute risks here — and in the second place, the treatment is not the most conservative, least invasive method for dealing with those risks. If keeping clean and wearing a condom are more effective, I find it ethically inappropriate to force an irreversible surgical procedure — with all its concomittant risks — on an individual incapable of consenting to such a treatment. This risk/benefit analysis is why no medical society recommends routine circumcision. One of the commenters on the above article also points to a 2002 article in the Journal of Medical Ethics, which has a decent treatment of the issues.
In my training, I have been learning how to perform these procedures. For my future practice, though, I’ve pretty much decided not to do them (although to avoid any hypocrisy, I will certainly refer them on should they request one).
Possibly related posts:
circumcision no doubt has possible adverse effects in rare cases. but in 1 of my 4 sons the lack of it caused an adhesion that made his erect penis crooked. general anesthesia was required for the circumcision, at age 14, that corrected it, but a simple infant circ would have been much less traumatic. none of my doctors would consider it when he was born. so i have mixed feelings about the matter.
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