Sunday, December 11, 2011

Circumcision: A Complete Rip-Off

Hey, everyone. If you know me well enough, you know that I am very much against routine infant circumcision. If you are on my facebook, you may have seen my research paper on the subject there. My English tutorial instructor has really emphasized that we should post our research papers to any blogs we may have and receive feedback from others. So, here it is :)

Circumcision: A Modern Medical Fraud

Americans are one of the few cultural groups that will make the decision on whether they will electively circumcise their newborn sons. Elective circumcision, also known as non-therapeutic circumcision, is circumcision in which there is no medical necessity. Non-therapeutic infant circumcision is an understandably controversial topic. While proponents of infant circumcision argue that it is acceptable because of cultural acceptance and potential benefits such as a possible decrease in urinary tract infections, opponents argue that these are not warranted reasons for infant circumcision. However, non-therapeutic circumcision of infants, in fact, should not be performed.
One of the many reasons non-therapeutic infant circumcision should not be performed is because it is not medically warranted. In fact, no major pediatric organization in the world recommends elective infant circumcision, and there is no medical reason to do so. The American Association of Pediatrics states in its policy that “while there is scientific evidence to demonstrate the potential medical benefits of circumcision, the data are not sufficient to recommend routine use of the procedure in newborn males” (“Routine” [1]). The Royal Australian College of Pediatrics also says, “The frequency of diseases modifiable by circumcision, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision” (“Circumcision” 5). Other pediatric medical organizations that do not recommend non-therapeutic circumcision include the Australasian Association of Paediatrics, Canadian Paediatric Society, the College of Physicians and Surgeons of Saskatchewan, the British Association of Paediatric Surgeons, and the Paediatric Society of New Zealand. The pediatric medical organizations listed represent a small number of those who do not recommend non-therapeutic infant circumcision.  Since no pediatric organization recommends non-therapeutic circumcision, it should not be performed. 
 Not only should non-therapeutic circumcision not be performed because it is not medically recommended, but it also should not be performed because the foreskin has a purpose. When a child is born without a foreskin, it is considered a birth defect.  The foreskin is not a mistake and is a part of the human anatomy for a reason. C.J. Cold, of the Health Sciences Centre, defines the foreskin, or prepuce, as a part of both the male and female genitalia that covers both the glans penis and clitoris (34). The male foreskin protects the glans against “urine, feces, and other types of irritation…. It [foreskin] protects against infection and scarring of the urinary opening” (Schmitt [1]).  When the foreskin is removed, the glans and urethral opening become more prone to infection. The greater vulnerability to infection ensues not only due to loss of cover, but also because the foreskin has immunological aspects. One immunological aspect is the protection against viral and bacterial infections through the process of enzyme secretion. According to Dr. Fleiss, the glands of the foreskin produce and secrete an enzyme known as lysozyme, an element of the immune system, which protects against bacteria and viruses ([5]). This role of protection is shattered by circumcision. Non-therapeutic circumcision should not be performed because it destroys the purpose and function of the foreskin.
Infant circumcision may also have undesirable physical and psychological effects. According to Christakis, MD, circumcision complication rates are one out of every 476 circumcisions (248). An estimated 1 in 500,000 boys die from circumcision (Benatar in Fox 164). Possible circumcision complications include, but are not limited to, adhesions, hemorrhage, penile amputation and even death. One out of every fifty circumcised infants will experience serious complications such as “seizure, heart attack, stroke, loss of penis, [or] death” (“Cut” [1]). Along with the aforementioned complications, circumcision has been found to alter the way the brain reacts to painful stimuli.  The American Academy of Pediatrics (AAP) confirms and acknowledges that circumcision affects a child’s response to pain. As a surgery, circumcision can be described as ‘“among the most painful performed in neonatal medicine’” (Goldman 93). The AAP also states that it is “noted that circumcised infants exhibit a stronger pain response to subsequent routine immunization than do uncircumcised infants” (American 688). The researchers of the study concerning immunization pain and circumcision concluded that “circumcision may induce long lasting changes in infant pain behavior” (Goldman 94). Circumcision is clearly an excruciatingly painful procedure, and infants should not be forced to endure the procedure unnecessarily. Non-therapeutic circumcision should not be performed on infants because of the complications that ensue and the fact that it increases the infants’ responses to pain.
            Circumcision may also have a psychological, as well as physical, impact. The American Academy of Pediatrics notes that there are “behavioral changes” such as increased irritability, “varying sleep patterns,” and changes in “infant-maternal interactions” after circumcision (Task 389).  An example of the negative psychological impact of circumcision is the story of a twin boy that was published in Time magazine. After a circumcision complication that left his penis damaged beyond repair, doctors urged the parents to have the boy undergo reconstructive surgery to make him anatomically correct to a woman, and his parents raised him female. When the boy was older he was given hormone treatments and the procedure was considered a success by the medical community. This case led to doctors’ urging parents to opt for the same procedure when similar incidences occurred. As the boy aged, he knew something was wrong with his body, and as a result became depressed and suicidal. When the boy’s parents realized what was happening psychologically with their son, they told him his story. Reconstructive surgery was then performed once again in an attempt to make him feel like the boy he knew he was. (Gorman [1-3]). This boy’s story is one of many and it could have been avoided. Because of the potential psychological trauma, non-therapeutic circumcision should not be performed.
Incidentally, routine circumcision violates a child’s right to his body. This is due to the fact that female circumcision is already illegal and non-therapeutic circumcision is a cosmetic procedure. Female circumcision was outlawed in 1997, yet male circumcision is still a cultural norm. The Female Genital Mutilation Act of 1995 states, “Except as provided in subsection (b), whoever knowingly circumcises, excises, or infibulates the whole or any part of the labia mojora or labia minora or clitoris of another person who has not attained the age of 18 years shall be fined under this title or imprisoned not more than 5 years, or both” (United [2]). Both males and females deserve the rights to their bodies. To say that the circumcision of one gender is wrong and the other is culturally acceptable is hypocrisy. According to Schultheiss, circumcision should not be allowed simply because of a cultural tradition and should be addressed ethically (24). The United States of America protects the rights of female children but not the rights of male children. The founder of Attorneys for the Rights of the Child, Steven Svoboda wrote that “American society evidently finds it very difficult to accept the profound importance of protecting the genital integrity of, at minimum, all individuals below the age of consent” (Svoboda in Denniston 189).  Males deserve the same protection as females, and infant circumcision should not be performed unnecessarily.
            Perhaps the most important reason that non-therapeutic circumcision should not be performed is the ethical aspects concerning it. Non-therapeutic circumcision is essentially cosmetic. Infants have the right to not have a cosmetic procedure performed on their body without their consent.  A cosmetic procedure is defined as, “Serving to modify…the appearance of a physical feature” (American [1]). When there is no medical indication for a procedure, and it is simply a body modification, it can be considered cosmetic. Cosmetic procedures are generally performed on adults who choose to alter their own bodies. No doctor would perform a cosmetic rhinoplasty or liposuction on an infant. Christine Schultheiss states in Penn Bioethics Journal; “There does not appear to be any way to justify cosmetic penile surgery if one rejects the ethicality of other types of cosmetic surgery for infants” (22-23).  If every other cosmetic surgery would be considered unethical, so should non-therapeutic infant circumcision. Dr. G.J. Boyle states that “Among other requirements, [doctors] are expected to respect the human rights of their child patients” (Boyle [2]).  Routine infant circumcision violates the male child’s right to his body and should not be electively performed.
Circumcision should not be performed on infants unless there is a medical need. The end of non-therapeutic circumcision is near as fewer parents are opting for this procedure. According to the Centers for Disease Control and Prevention, the circumcision rate has dropped to 32.5% in the United States (Rabin [1]). The drop in statistics is largely due to parents becoming more informed about the potential adverse outcomes of circumcision and the fact that it is not medically necessary.  The imbedding of circumcision in American culture should be pushed aside because circumcision is not just a decision that is being made for the child, but for the man he will become because, of course, once a child is circumcised, he remains circumcised permanently, and the adult man has to live with the consequences of someone else’s decision.

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