 |
 |
 |
 |
 |
|
Circumcision: Reevaluating a Time-Honoured Practice by Cynthia Dusseault Parents and/or guardians do not have the right to consent to the surgical removal or modification of their children's normal genitalia. (from the Declaration of the First International Symposium on Circumcision, Anaheim, California, March 3, 1989) This statement was made ten years ago, but the circumcision debate began long before then, and will continue well into the future. Why? Because the practice of circumcision is rooted so deeply in the cultural, religious, and social history of humankind¾ and particularly in mainstream North American society¾ that the law is afraid to touch it, many individuals find it taboo to even discuss it, and the majority of people know amazingly little about it. Circumcision is a procedure that involves pulling back and separating the foreskin from the head of the penis, which it covers, and then cutting it off. In many African tribes, circumcision was¾ and still is¾ performed on young boys as a rite of initiation into manhood. For Jewish people, who have been practicing circumcision for centuries, its significance is purely religious, outlined in the Torah, their holy book, as a covenant they have with God. Today, however, the Jewish community is divided on this issue. Although Orthodox Jews argue that the Torah is the word of God and must be obeyed verbatim, many Reform Jews argue that the covenant they have with God is a partnership, and that neither partner is meant to be a slave to the other. Circumcision, therefore, is a choice. They also argue that circumcision goes against some of the basic tenements of Jewish law, which forbids the cutting or marking of the human body, torture, or the causing of pain. Non-Jewish people debate too, about the practice of circumcision, but this debate centres around issues relating to health, sexuality, and human rights. In North America, where upwards of 60% of male infants are routinely circumcised (in a world where upwards of 80% of men are not), circumcision has come under much scrutiny in recent years. Medical professionals are re-evaluating the evidence¾ or lack of evidence¾ that boosted circumcision to its current popularity. Parents, as well as other individuals and organizations, are examining the moral and ethical issues surrounding circumcision. And many men are beginning to realize that being circumcised has adversely affected their sexual functioning. The North American trend to routinely circumcise male infants may soon be on the downswing however, for in the March 1999 issue of Pediatrics the new "Circumcision Policy Statement" of the American Academy of Pediatrics (AAP) was published. And, from a purely medical perspective, this new policy states that the AAP cannot find sufficient evidence to recommend the routine circumcision of newborn males. It critically reexamines the following four main issues that in the past were always presented as pro-circumcision arguments: UTI (urinary tract infection) Although evidence does seem to indicate that circumcized males have slightly lower incidences of UTI in comparison with uncircumcized males¾ and this more notable in infants under one year of age¾ the AAP points out that because so many other variables (i.e., the effects of prematurity and breastfeeding) seem to be significant as well, the evidence is far from conclusive. And, with the risk of UTI in uncircumcized infants in the first year of life being low (no more than 1 in 100), it hardly warrants the performing of an invasive surgical procedure, such as circumcision, merely as a precautionary measure. Penile Cancer Evidence seems to indicate that circumcized men have lower incidences of penile cancer than uncircumcized men, but again the AAP points out that there are many other risk factors that require further study. These include phimosis (a condition in which the opening of the foreskin is constricted, and which may be linked to poor hygiene), genital warts, numbers of sexual partners, and cigarette smoking. Also, because the incidence of penile cancer is so low (9 to 10 cases per million in the United States), the benefit of routine circumcision is virtually negligible. STDs (sexually transmitted diseases) Although the mucosal surface of an uncircumcized penis seems to be more prone to viral attachment and infection than the circumcized penis, the AAP policy maintains that behavioural practices are the main risk factors for STDs and HIV. What the AAP policy doesn't explicitly state, but what the bottom line really is, is that no matter what the studies may show in terms of STD and HIV incidence in circumcized versus uncircumcized men, circumcision cannot justifiably be recommended as a means of compensating for unsafe, irresponsible sexual practices. Pain/Analgesia The AAP recognizes that, contrary to what people have been told for many years, infants who undergo circumcision do experience pain. This pain can be physiologically detected, and can have long term effects on the pain tolerance of these individuals. The AAP policy therefore recommends that anaesthesia be used if circumcision is performed, and of the three main anaesthesia options¾ EMLA cream, Dorsal Penile Nerve Block, and a subcutaneous ring block¾ it recommends the latter as being the most effective. The new AAP policy is essentially a semi-stand on circumcision, because it only addresses medical issues. In the end, the policy clearly gives the decision back to parents, advising them to consider current medical information as well as "cultural, religious, and ethnic traditions." These are clearly important considerations, but there are other issues at stake as well. What about the rights of the child, and of the man whom that child will become? What about the growing body of evidence about sexual dysfunctioning as a result of circumcision? And, in a society where differences are celebrated, is it really necessary for sons, underneath their clothing, to look like their fathers? Whose body is really the normal, natural one? Legally, everywhere in the world, parents still have the power to decide whether or not to circumcize their baby boys. This power must be wielded carefully, and the decision not made lightly. References:
|
