Some toddlers and young children have a condition called phimosis, where the foreskin is too tight to be retracted (pulled back) over the head of the penis. Some observational studies have found that adult men who were circumcised as babies were less likely to get penile cancer. They also think that at this period consent is given by the parents, and neonates should be allowed to grow till adolescence when they can give consent by themselves. PMC Circumcision -- in which the foreskin on a penis is cut off -- was uncommon in the United States until the late 1800s, when doctors started recommending it as a way to curtail masturbation in young boys. To reduce complications, the circumcision should be done by a trained practitioner typically an obstetrician, sometimes a pediatrician who uses sterile techniques. However, new research has fueled the debate over the . "All mammals have foreskin," says George C. Denniston, MD, MPH, director of the nonprofit group Doctors Against Circumcision. The device is placed on the penis and after separating the glans and foreskin, the string is used to shut off the blood supply. We'll answer questions or respond to your comments, just make sure you enter your email address. [15,16] If these functions are important, why then should the prepuce be removed? Still, the details of circumcision really are unsettling. National Library of Medicine "Northern California is the hotbed for anti-circumcision groups," said Wiswell. Infant circumcision is generally safe, with a complication rate of about 1.5 percent. It has made us aware that neonatal circumcision is not a simple procedure and that it should not be regarded as "routine." The excess foreskin is cut with a scissor and the patient is sent home with the bell covering the penis until the bell falls off on its own, like an umbilical cord. circumcision has been a subject of controversy for a number of reasons including religious, ethical, sexual, and medical. For decades in this country, it was considered a routine step in the birthing process, much like cutting the umbilical cord. Circumcision is the surgical removal of the foreskin, the tissue covering the head (glans) of the penis. As an anthropologist, Glick offers insightful readings of how circumcision might have functioned in different Jewish cultures. Glick is not the first to narrate the gruesome details of circumcision but that doesnt stop him from piling on plenty of stretching, cutting and bloodletting detail. Circumcision -- in which the foreskin on a penis is cut off -- was uncommon in the United States until the late 1800s, when doctors started recommending it as a way to curtail masturbation in. Philip Roth, in a letter quoted toward the end of Marked in Your Flesh, makes a point that Glick himself seems to miss, and that says much about the perverse appeal of a practice that is so violent, painful and irreversible. Some plans do not cover circumcision in newborns, after 30 days of life. In the 19th century, some leaders of the then-nascent Reform movement, objected to circumcision, with one such leader, Germanys Abraham Geiger, describing it as a barbaric, bloody act, according to Louis Jacobs The Jewish Religion: A Companion. Were happy to make this story available to republish for free, unless it originated with JTA, Haaretz or another publication (as indicated on the article) and as long as you follow our guidelines. Bottom line? The American Academy of Pediatrics met last summer on the issue and is still considering whether to issue new guidelines. The authors of this article wrote a review article on circumcision in 1981 and Dr. Grossman has recently published a book designed to teach proper circumcision technique, and to familiarize the operator with the common congenital anomalies as well as the prevention and treatment of the complications of circumcision. "I was okay with it, though, because it was done under general {anesthesia} for medical reasons. For some, it has an absolute religious indication, which transcends current medical logic. official website and that any information you provide is encrypted What Glick tries to show in Marked in Your Flesh is that all the original reasons for circumcision are dubious. "For instance, whether the father is circumcised. 2 The circumcision controversy is accorded crucial significance in any historical explanation of the rise of political nationalism, 3 any discussion of faith, education or culture in the making of modern Kenya 4 . Risks include bleeding, infection and, most uncommonly, injury to or removal of the penis. transmission; some have suggested that tiny abrasions in the delicate foreskin, combined with a warm, moist environment, may leave uncircumcised men more vulnerable to infection. The perception of pain has to do with both physiology and emotional responses. "And a lot of people who are worried talk about ethics -- is it okay without the child's consent? [1] The procedure has continued to date, with several issues and ideas conflicting the practice. "But that's not to say all boys should be circumcised, because it is not purely a medical decision.". You must credit the Forward, retain our pixel and preserve our canonical link in Google search. To put it mildly, circumcision is a delicate subject. The medical indications for circumcision have been largely attributed to infection of the prepuce (prosthitis), glans (balanitis) or both (balanoprosthitis), obstruction of the urethra (Phimosis, paraphimosis), and malignancy of the glans penis. An untreated adhesion can go on to form a thickened band of skin called a skin bridge, which may need to be surgically removed. Understand that the risks of circumcision are low. In order to discuss infant UTI intelligently, it is first necessary to understand the . This guide was originally published on July 12, 2019 in NYT Parenting. The procedure also reduces the risk of urinary tract infections in infants by 90% and the risk of penile cancer in older men by 50% or more. The doctor or mohel then pushes the glans back and places the thin sliver of foreskin into the clamp, much like a guillotine that quickly amputates it. This is often done while a newborn is still in the hospital, using local anesthetic, by an obstetrician or pediatrician. 2001 Dec;48(6):1539-57. doi: 10.1016/s0031-3955(05)70390-4. Why do loving parents allow such things to happen? However, the H.I.V. Convinced that there is no rational basis for this practice, he imputes religious bias onto those who believe that there is. Glick writes that deepest significance of circumcision resides not in abstract spiritual realms but in the basic facts of social life: sexuality and masculinity, power and weakness, dominance and submission. This is a false dichotomy. The reason? To those who take brit milah the covenant of circumcision for granted, the contemporary debate around the practice may come as a surprise. Lee-Huang S, Huang PL, Sun Y, Huang PL, Kung H, Blithe DL, et al. Lately, however, the debate has moved into the mainstream. official website and that any information you provide is encrypted "Most babies who are uncircumcised don't get {urinary tract infections} and don't have trouble with their foreskin," said Newman, who reported his findings at the May meeting of the American Academy of Pediatrics meeting in Washington. . That circumcision reduces sexual pleasure, and that it is fully experienced by the traumatized infant, is now well established. In The Female Circumcision Controversy, Ellen Gruenbaum points out that Western outrage and Western efforts to stop genital mutilation often provoke a strong backlash from people in the countries where the practice is common. Some physicians recommend the procedure only for certain newborns. The baby is placed on his back, legs apart. On the other hand, maybe not. Since both Jewish and Islamic religious traditions promote the procedure, circumcision rates are over 95 percent in parts of the Middle East. Ellen Gruenbaum is Professor of Anthropology at Purdue University. In rare cases, a childs foreskin may not relax on its own, a condition called phimosis. Therefore, to reduce complications, it is important to train, master a particular method, and be proficient in it. Pediatrics, March 1999; vol: 103, pp 686-693. Yet a book published by Oxford University Press, by a noted Jewish anthropologist, has at least one unambiguous effect: It raises the stakes of the conversation. At the same time, the rate of urinary tract infections is generally very low. [3] Culture and religion do not advance any scientific basis for the procedure. In every society there are traditional barbers, untrained personnel, and surgeons who are dedicated to the practice of circumcision. Disclaimer. Its almost impossible to discuss the matter without cracking a joke, probably because the ritual makes at least 49% of the population wince and cross its legs. But one wonders if the current wave of anti-circumcision backlash, formerly the domain of marginal eccentrics but now the purview of Oxford University Press, might cause the practice to diminish in importance. The main medical benefit associated with circumcision is a reduced risk of infections. For babies and young boys, there is a lower risk of infant urinary tract infections if they are circumcised. The Circumcision Controversy: The Risks and Benefits of Circumcision for Babies Circumcision is one of today's most controversial parenting topics. Gehremedhin S. Assessment of the protective effect of male circumcision from HIV infection and sexually transmitted diseases: Evidence from 18 demographic and health surveys in Sub-Saharan Africa. But complicating the debate now are recent studies that do show some medical benefits: Circumcised men have a lower risk of getting HIV and other sexually transmitted diseases. Intact America is the sponsor of this website. Unauthorized use of these marks is strictly prohibited. Circumcision, the removal of the fold of skin covering the tip of the penis (called the foreskin, or prepuce), has not always been embroiled in controversy. Fetus and Newborn Committee, Canadian Paediatric Society. Bandages must be changed daily. An overview of ceremonies to welcome baby boys and girls. Sari N, Buyukunal SN, Zulfikar B. Circumcision ceremonies at the Ottoman Palace. So did the initial proponents of medical circumcision in Britain and America. Nowadays the question is not only whether to circumcise, but if so, whether the newborn needs anesthesia. Originally published in the March/April 2008 issue ofWebMD the Magazine. Even with these flaws, though, Marked in Your Flesh is a fascinating read. Other doctors may use a plastic device that is shaped like a small bell and has a handle and a string. Every day, Jewish boys are having their sexual organs damaged without their consent and even without the knowing consent of their parents, who, if they knew the costs, might well agree with Glick that the spiritual and possible health benefits do not justify them. Journal of Surgical Technique and Case Report. An uncircumcised infants foreskin is naturally tight, but will relax as the child grows. OHara K, OHara J. They also advised parents to learn how to care for their sons penis, with or without a foreskin, and how to recognize complications. They also need to be enlightened on what sort of circumcisions to refer, where and how to refer a patient if a circumcision goes wrong. Excess bleeding may signal a rare infection, but tiny bits of oozing blood or redness is common and the expected reaction to the removal of a layer of skin. Unlike in Europe, where the procedure never caught on, many American parents continued to believe a circumcised penis was easier to keep clean (it's not) and many wanted their sons to look like their fathers. In 2013, The Washington Post reported that a small but growing number of Jews are questioning the ancient ritual of circumcision. That article noted that even some parents who were having their sons circumcised, are avoiding having a public brit milah ceremony, feeling that this celebration of the rite is unseemly. They may not know it consciously, but they have all of the equipment to perceive it," said Anna Taddio, clinical pharmacologist at the Hospital for Sick Children in Toronto. Indeed very little is known about infant pain at all. Circumcision has always been a controversial, and on a world scale, a minority practice. The Female Circumcision Controversy: An Anthropological Perspective. American Academy of Pediatrics: "Circumcision Policy Statement," Recently much discussion in the circumcision controversy has centered on the issue of infant urinary tract infections (UTI). Circumcision, the removal of the fold of skin covering the tip of the penis (called the foreskin, or prepuce), has not always been embroiled in controversy. Cutting the natural genitals of a child, in the absence of medical necessity, violates basic bioethical principles of autonomy, justice, beneficence, and nonmaleficence (do no harm). The free-hand methods are: The dorsal slit and the guillotine. This article on our partner site Kveller explains the numerous reasons for circumcision. The procedure generally is covered by insurance, including Medicaid. Federal government websites often end in .gov or .mil. Complications occur more often when the right size of the appliance is not used, or in the hands of the untrained. Immunologically the prepuce has been known to secrete substances with anti-HIV components and is a barrier to HIV-1 transmission. The other issue is that, if the prepuce secretes substances that prevent HIV-1 transmission, then what reduces the risk of HIV infection in those circumcised? The procedure is quick, lasting only 10 to 15 minutes, and parents may be present if they wish. The amount of preputial skin to be removed has generated much argument among experts in this field. Urol Clin North Am. If one has the perception that there is value in improving local hygiene, or that the loss of the prepuce will allow for an earlier discovery of a penile lesion, or that circumcision actually does cause a decrease in the incidence of penile or cervical cancer, or group conformity is important, then one might well advocate neonatal circumcision. George C. Denniston, MD, MPH, director, Doctors Against Circumcision. This, therefore, leaves the question of whether circumcision is necessary in the first place.[4]. It is mentioned only to be condemned emphatically. Wiswell T, Hackey W. Urinary tract infection and uncircumcised state: An update. In doing so, she explores both outsider and insider . CDC: "Male Circumcision and Risk for HIV Transmission: Implications for Quinn, T. Current Opinion in Infectious Diseases, February 2007; vol "So I don't think we, as doctors, can say this is a procedure we should do because of the medical benefits. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). If you dont circumcise your baby, leave things alone. Department of Surgery, Pediatric Surgery Unit, Usmanu Danfodiyo University and Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. [4] There has really been no consensus on the above-mentioned issue. Prevention of urinary tract infections is considered the most compelling medical benefit of infant circumcision in the United States, said Dr. Ellen Shapiro, M.D., director of pediatric urology and a professor of urology at NYU Langone Medical Center. In: Denniston GC, Milos MF, editors. little evidence on either side that provides a clear right or wrong answer. Immunological functions of the human prepuce. It can be so painful that many pediatricians recommend using nerve blocks as well as a local anesthetic. This may not apply in our environment and other settings where circumcision is mostly done by traditional or untrained individuals. National Hospital Discharge Survey, 2003. Right now, there is a dont ask/dont tell policy within much of institutional Judaism when it comes to parents skipping circumcision, Rebecca Wald, the founder of Beyond the Bris, an online community for parents who are questioning circumcision, told the Times. If you plan to circumcise your son, it is best to do it before 6 weeks of age; afterward, circumcision must be done with general anesthesia in an operating room. Its grisly details will make most readers cringe, and the evidence of the damage done by circumcision is sound. There are free-hand surgical methods and a method involving the use of appliances. Wamai RG, Morris BJ, Bailis SA, Sokal D, Klauser JD, Appleton R, et al. The Female Circumcision Controversy: An Anthropological Perspective Authors: Alma Gottlieb Brown University Abstract The Female Circumcision Controversy: An Anthropological Perspective. By combining the results with the findings of other investigations, researchers concluded that the procedure reduced the rate of urinary tract infections from about 1 percent among uncircumcised men to 0.1 percent among the circumcised. Later circumcision: From toddler to adults, Experts say that circumcision is less risky (and less expensive) when done in infancy. We're not wandering around Egypt any more. Circumcision Policy Statement. My experience is that, more often than not, parents want the kid to look like the dad so if the dad is circumcised he thinks that is what a penis should look like.". At the outset, Glicks reading of the biblical text is really more a midrash than biblical criticism; it is good speculation, but only that. The case against circumcision. The decision was legislatively overruled in late 2012, though public comment persisted. The most controversial part of the book is where Glick claims that Jewish doctors, and some doctors who are Christian, were swayed by their religious opinions to color the evidence in favor of circumcision. Glick also labels as Orthodox the opponents of early Reform, who did not identify in that way and who were not identified that way until decades later and only then, in a derogatory fashion, by the Reformers themselves. doi: 10.1542/peds.2012-1990. And the medical risks are not compelling enough to recommend against it. Its hard to understand, Roth writes, how serious this circumcision business is to Jews. See our full guidelines for more information, and this guide for detail about canonical URLs. Glick is no more objective when it comes to the medical evidence. biostatistics and pediatrics, University of California, San Francisco. If you need to flag this entry as abusive, According to the Center for Disease Control and Prevention (CDC), circumcision is less risky (and less expensive). Learn more. E-mail: moc.oohay@sirhcgnokul. We are dealing with the art of medicine rather than science. However, critics of the practice say the benefits are not . Regarded as `` routine. Surgery Unit, Usmanu Danfodiyo University and Usmanu Danfodiyo University and Usmanu University., with a complication rate of urinary circumcision controversy infection and, most,. 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