Appendix 7 - Circumcision

by Michael Greger, MD and United Progressive Alumni

[ Medical School Resources | Appendices | Discussion ]

Then Zipporah took a sharp stone... - Exodus, 4:25

According to U.S. News & World Report, "Attitudes are changing and neonatal circumcision rates have dropped steadily during the past three decades from 90 percent to 64 percent."[93] On the West Coast, hospital circumcision rates are already down to 34%.[94] Circumcision still, however, remains the most commonly performed surgery in the country.

America is the only country in the Western world that routinely circumcises.[95] In Western Europe, for example, less than 10% of newborn boys are circumcised.[96] The vast majority of the world's men are uncircumcised.[97]

According to an article in Postgraduate Medicine, "Physicians in English-speaking countries adopted [routine] circumcision as a cure for masturbation during the latter part of the 19th century."[98] From the medical literature at the time: "The foreskin is a frequent factor in the causation of masturbation...."[99] "In all cases of masturbation, circumcision is undoubtedly the physician's closest friend and ally...."[100] "It is the moral duty of every physician to encourage circumcision in the young."[101]

From an article in Men's Health:

In 1888, John Harvey Kellogg, MD, of cereal fame, summed up the medical profession's opinion and gave justification for the next 60 years of foreskin removal: 'A remedy for masturbation which is almost always successful in small boys is circumcision. The operation should be performed by a surgeon without administering an anesthetic, as the pain attending the operation will have a salutary effect upon the mind.'[102]

My own preference, if I had the good fortune to have another son, would be to leave his little penis alone - Benjamin Spock

Why have American docs continued this practice? One reason may be that research has shown that uncircumcised infants may have more urinary tract infections. "Do you treat an infection with surgery?" one physician counters.[103] From a letter in American Medical News: "Circumcision is not a medical decision. Preventing an improbable future infection is a spurious indication. The standard of care is antibiotics, not amputation."[104]

Dr. Spock points out another reason. "Scientists used to think that the wives of uncircumcised men were more likely to get cervical cancer, but research has disproved this."[105] From the American Cancer Society: "Research suggesting a pattern in the circumcision status of partners of women with cervical cancer is methodologically flawed, outdated, and has not been taken seriously in the medical community for decades."

What about penile cancer, though? Penile cancer rates in many countries that do not practice circumcision are lower than those found in the United States. In fact, in 1996, representatives of the American Cancer Society wrote a letter to the American Academy of Pediatrics pointing out that, "fatalities caused by circumcision accidents may approximate the mortality rate from penile cancer.... Perpetuating the mistaken belief that circumcision prevents cancer is inappropriate.'"[106]

"There is no proven, documented medical reason that says circumcision is better," says Karin Blakemore, director of the maternal-fetal medicine division at Johns Hopkins University School of Medicine.[107] Between an estimated 2 and 50 infants die every year in the U.S. due to complications from circumcision.[108],[109]

One reason that circumcision may be so popular in the United States is that it is estimated to be a $400 million business. The usual insurance reimbursement to doctors is around $95. According to the Men's Health article, a busy doctor could generate $25,000 a year from circumcisions alone.[110]

Keep the Tip

Most of the world's leading medical establishments have come out against the surgery. "Circumcision of newborns should not be routinely performed," says the Canadian Paediatric Society. "To circumcise... would be unethical and inappropriate," says the British Medical Association. The Australasian Association of Paediatric Surgeons states: "Neonatal male circumcision has no medical indication. It is a traumatic procedure performed without anesthesia to remove a normal, functional and protective prepuce."[111]

March 1999, the American Academy of Pediatrics issued a new circumcision policy statement.[112] The new policy describes the existing evidence as, "not sufficient to recommend routine neonatal circumcision."[113] And for the first time, the policy says that if parents do circumcise a son, for whatever reason, relieving pain is essential."[114] One would think that would go without saying.

The Gift that Keeps on Giving

Still heeding the words of the breakfast mogul a century later, most doctors in U.S. hospitals do not use anything to dull the pain.[115] The medical community used to think that infants couldn't feel pain at all. Now the question has shifted to, how long does the hurt from circumcision last? According to one researcher, "Circumcision causes such traumatic pain in newborns that it may have damaging effects upon the developing brain."[116]

Preliminary studies suggested that pain experienced by infants could have long-lasting effects on the infant's future behavior, so researchers decided to study circumcision. They took two groups of infant boys, similar except that one group was circumcised and the other was not. They followed them months down the road until their 4 and 6-month vaccinations. Would the circumcised babies be so traumatized by their circumcision that they would show a stronger pain response to the injections? Using standard pain indicators - infant facial action, cry duration, and visual analog scale pain scores - they did indeed show a significantly different response to pain based on whether they were circumcised or not at birth. The study concludes, "Circumcised infants showed a stronger pain response to subsequent routine vaccination than uncircumcised infants (p<.001)."[117]

Parental Guidance

Even if it was made to be painless, George Denniston - a Seattle physician and founder of Doctors Opposing Circumcision - asserts, "The practice violates all seven principles of the American Medical Association's code of ethics."[118] As currently practiced in U.S. hospitals, circumcision is essentially cosmetic surgery not only done without anesthesia, but done, obviously, without the informed consent of the patient. According to the American Academy of Pediatrics Committee on Bioethics, "Parental permission [as proxy consent] is only acceptable in situations where medical intervention has a clear and immediate medical necessity."[119]

Babies are not property. If parents are so sure the child would approve, why not wait until he's old enough to make up his own mind? I doubt many teens would go under the knife.


[93] Lowen, SJ. "Rethinking a Custom." U.S. News & World Report 15 June 1998:66.

[94] Jenkins, M. "Separated at Birth." Men's Health 13(1998):130.

[95] Ibid.

[96] Lowen, SJ. "Rethinking a Custom." U.S. News & World Report 15 June 1998:66.

[97] Jenkins, M. "Separated at Birth." Men's Health 13(1998):130.

[98] Metcalf, T. "Routine Neonatal Circumcision?" Postgraduate Medicine 84(1988):99-108.

[99] Wolbarst, AL. "Universal Circumcision as a Sanitary Measure." Journal of the American Medical Association 62(1914):92-97.

[100] Spratling, EJ. "Masturbation in the Adult" Medical Record 24(1895):442-443.

[101] Wolbarst, AL. "Universal Circumcision as a Sanitary Measure." Journal of the American Medical Association 62(1914):92-97.

[102] Jenkins, M. "Separated at Birth." Men's Health 13(1998):130.

[103] Cornell, S. "Controversies in Circumcision." Advance for Nurse Practitioners 1997(October):49-52,78.

[104] Letter. American Medical News 27 July 1998:27.

[105] Dr. Spock's Baby and Child Care, 1992.

[106] Jenkins, M. "Separated at Birth." Men's Health 13(1998):130.

[107] Lowen, SJ. "Rethinking a Custom." U.S. News & World Report 15 June 1998:66.

[108] Thompson, RS. "An Opposing View." Journal of Family Practice 31(1990):189-196.

[109] American Academy of Pediatrics. "Circumcision Policy Statement." Pediatrics 103(1999):686-693.

[110] Jenkins, M. "Separated at Birth." Men's Health 13(1998):130.

[111] Ibid.

[112] Stead, D. "Circumcision's Pain and Benefits Re-Examined." New York Times 2 March 1999:F6.

[113] American Academy of Pediatrics. "Circumcision Policy Statement." Pediatrics 103(1999):686-693.

[114] Stead, D. "Circumcision's Pain and Benefits Re-Examined." New York Times 2 March 1999:F6.

[115] Stang, HJ and Snellman, LW. "Circumcision Practice Patterns in the United States." Pediatrics 101(1998):1066.

[116] Jenkins, M. "Separated at Birth." Men's Health 13(1998):130.

[117] Taddio, A, et al. "Effect of Neonatal Circumcision on Pain Response During Subsequent Routine Vaccination." The Lancet 349(1997):599-603.

[118] Jenkins, M. "Separated at Birth." Men's Health 13(1998):130.

[119] Letter. Journal of the American Osteopathic Association 96(1996):273.

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