Thursday, December 1, 2011

A Healthy Dose of Doubt

Circumcision is becoming a hot topic for today’s expecting parents. Word is out that not only has circumcision been considered medically unnecessary since the 70’s , (even though it hasn’t been common knowledge) but also that it’s damaging! Delving into this country’s circumcision past is a disturbing enough journey; but what’s most surprising is that the cruelty and racism that seem to surround the promotion of this controversial surgery aren’t only buried in the past, but are still alive today.

There’s more to know about circumcision than most people would guess. After hearing that it’s quick, painless, and beneficial for so long, it seems at first like there wouldn’t be much there if you went digging. Parents are taking a much more active roll in this decision than ever before, and discovering for themselves just how much has been kept out of sight. Like the protective and sexual value of the foreskin, the damage that occurs from a “proper” circumcision, or the horrific disfigurement when something goes wrong . In addition to the many reasons to leave our sons intact, we are finding out about the surprising number of men who are restoring their foreskin naturally, in an attempt to get back what they feel was wrongfully taken from them .

But let’s start at the beginning. A little over 100 years ago, scientists knew little about the nervous system, and thought that nervous tension from masturbation would have negative health consequences . Because of this, coupled with the accepted social idea that masturbation was an evil, they began circumcising young boys (not babies) as a punishment for, or prophylactic against it. They would even refuse to use pain relief, so that the “…pain attending the operation will have a salut[a]ry effect upon the mind, especially, if it is connected with the idea of punishment…” . They knew that the foreskin was a sensitive part of the penis, and felt that society as a whole would benefit from males being less sexually stimulated . As more and more doctors began doing circumcision, the claims of its benefits grew wilder and wilder, they even alleged that it would cure diseases like tuberculosis and epilepsy .

Some racist doctors promoting circumcision attempted to use it to further the oppression of African Americans by insisting that circumcision should be forced upon all black males because they were rapists of white women. “…we feel fully warranted in suggesting the wholesale circumcision of the Negro race as an efficient remedy in preventing the predisposition to discriminate raping so inherent in that race.” . At the time, racism was so commonplace that it could be spouted by professionals, and without a second thought, accepted by the public.

The original claimed benefits of circumcision were not based on scientific research. They were based on assumptions, and racial and social profiling. It was said many times that the Jewish population was immune to, or nearly free of different diseases, and that circumcision must be the key . During those times, and even for years to come, it seems it wasn’t necessary to prove anything or do research first. If you were a doctor and you saw a pattern in your clientele, you could publish your hunch, and it became fact . People obviously put a tremendous amount of trust in the medical community, even to the point of abandoning their own rationale, in order to believe that cutting off a part of the penis would cure a lung disease or brain problem.

As time went by circumcision was said to cure or prevent each new scary disease as it gained popularity. Doctors found a reason to circumcise in everything from cervical cancer, down to the simplest things that we would never perform surgery on a girl for: diaper rash. As recently as 2005, one self named circumcision expert, Dr. E. Schoen even gives bigotry along class and nationality lines as a valid reason to circumcise: "The American public doesn't take well to the idea of using the rest of the world as a model. U.S[sic] parents don't want to follow the health practices of millions of 'intact' Hindus in the ghettos of India, or of the hordes of uncircumcised peasants in China." Today, however, doubting what doctors have to say when they sound ridiculous isn’t looked at with scorn; getting a second opinion is considered an intelligent thing to do.

So what are we finding out? The American Cancer Society states: “Most experts agree that circumcision should not be recommended as a way to prevent penile cancer.” Using what we know about other cancers: that behavior and environment often play the biggest roles, we can see for ourselves that cutting off a body part to prevent cancer is silly. We don’t cut the breast tissue from our infant girls even though breast cancer is about twenty times more likely than penile cancer. Believing that circumcision prevents penile cancer could even be detrimental to a man’s health if it allowed him to ignore the real risk factors, like smoking and promiscuous behavior.

The American Academy of Pediatrics casts doubt on studies showing a lower incidence of urinary tract infection among circumcised boys because of unaccounted for confounding factors . (These are things that have an effect, but weren’t studied.) Again, once we think about the fact that UTI is much more common in women than in men, we can rely on our common sense to see that surgical amputation prior to an actual infection (or even for one) is overkill. Especially when UTIs are easily treated with antibiotics. After all, what do we do for a circumcised boy who gets a UTI? Compared with the conservative medical treatment that women receive, circumcision promotion starts to look pretty sexist.

Currently, there is no national or international medical organization that recommends the routine circumcision of infants.

So we are learning that this simple painless surgery is unnecessary, and what’s more, that it is not simple, and it is far from painless. Back when doctors began to perform circumcision on infants instead of children, they assumed the differences they found in infant nerves meant that they were incapable of feeling pain. They would go so far as to perform open-heart surgery with nothing but a paralyzing drug . And so circumcisions were performed without anesthesia for years. The tradition of ignoring the cries of an infant being circumcised has continued, regardless of the discovery that infants in fact feel more intense pain than adults do , and that the pain has a lasting effect, rather than being forgotten . Even though pain relief is recommended, many circumcisions are still performed without it. If there is a topical pain reliever, i.e. EMLA cream, it may not penetrate through both folds of foreskin and the glans (penis head) where it is needed. This is where the membrane connecting the foreskin to the glans is torn away with a blunt probe. Other pain relief requires one or more injections in the groin. I have a hunch that this would be painful too.

The worst of what we’re learning though, is that circumcision carries damages even if it is not considered botched. Once we believed that the foreskin was just a useless flap of skin, so if a baby was lucky enough not to have one or more of the dozens of complications, like bleeding, infection, loss of other structures or entire penis, skin bridges, meatal stenosis, death, etc., then he made out okay. But now we know what the doctors of the past were trying to deny us. Not only does new research out there show us a desensitization of the glans in circumcised males , and the presence of thousands of sexually responsive nerve endings and specialized structures in the foreskin , but we are stopping to think for ourselves: if it’s part of a sex organ, perhaps it has a sexual purpose. If it’s not a birth defect, and surgery has risks, perhaps it’s ok to leave it alone. And if it’s on someone else’s body, perhaps we should let them decide for themselves. We don’t need scientists to tell us that.

Some people out there still promote medical benefits from circumcision regardless of the damage, common sense, ethical issues, and, as it turns out, international statistics. Some would have you believe that circumcision will prevent the contraction of HIV. A quick look at a UNAIDS map shows that the UK, Finland, Sweden, Norway, Italy, France, Germany, Poland, China, Japan, and more nations that do not circumcise have a lower rate of HIV than the U.S.

Most men in this country, I would wager, if told: “congratulations, your circumcision is going to keep you from getting AIDS” would still adamantly refuse to engage in unprotected sex with someone they knew was HIV positive. Women as well, would have the common sense not to believe that a man was a “safe bet” just because he had been circumcised. There are, after all, plenty of men, circumcised at birth, who contracted HIV from heterosexual intercourse, and who have died of AIDS. But that’s us, we’re savvy, ready to doubt, ready to check facts, with a common sense that has been developed and nurtured in the prosperous U.S.A.

Now what is interesting isn’t what the circumcision advocates are saying, because that’s really the same, but who they’re saying it to. Far away from the educated patients of the wealthy United States, in a place where the threat of contracting HIV is a looming everyday reality shrouded in ignorance, foreign doctors with big money are being trusted, just as the doctors of our past were trusted by us. I’m referring to the scientists in Africa trying to prove that circumcision prevents HIV infection. There are programs already in place attempting to circumcise as many men as possible despite the fact that there has been very little research done, and that it has received a great deal of professional criticism . With the zealous help of the media, circumcision is once again believed to be the newest medical miracle, and stories of a new AIDS prevention has spread like wildfire. Now these poor, uneducated people, desperate for hope, are hearing dangerous rumors and believing them to be fact.

This irresponsible and unfounded touting of circumcision as an AIDS prevention is causing trouble for Africans. A recent article from Swaziland quotes a local doctor: “Many of the men I speak with think circumcision is like an AIDS vaccine.” With less sexual sensation, and belief of immunity, men are refusing to wear condoms, as one wife attests: "He [my husband] was circumcised and felt he didn't have to wear a condom. When we found we had HIV after testing, he blamed me.” Women are abused if not abandoned in this scenario. An HIV support group founder is quoted as well: "Families blame women when HIV comes into the house, and it results in all sorts of abuse, from physical abuse to denial of spousal and child support, and loss of property rights."

Risky behavior that leads to more infection, beliefs that lead to abuse and the destruction of the family; it all renders the supposed protection of circumcision moot. Just like the loss of sexual sensation only to wear a condom anyway renders all the expense and risk of surgery moot. Speaking of expense, is it really worth the money being spent? It brings me back to my point about common sense. I don’t need to see graphs or reports for something that obvious: condoms are cheaper, safer, and more effective than surgery. Just imagine the amount of condoms and education that could be bought with all the money spent on this ‘research’ and surgical intervention.

Circumcision promotion seems to be carrying on a tradition of bad science, the disregard of the value of people’s lives, rights, and bodies, and the vilifying of a natural body part and all those who have it. We’re getting wiser to it by the day, and by the time all of the real care for Africa takes effect, reducing HIV/AIDS, and the pushers come back to us trying to say it was circumcision that did it, we’ll be ready to call it what it is.

sorry, my footnote numbers don't show up.

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The Use of Male Circumcision to Prevent HIV Infection, A Statement by Doctors Opposing Circumcision. Found at:
Reuters AlertNet, SWAZILAND: Circumcision gives men an excuse not to use condoms, July 31, 2008.

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