Below the Belt: Doctors, Debate, and the Ongoing American Discussion of Routine Neonatal Male Circumcision

Abstract

There has been considerable controversy surrounding the routine circumcision of male infants in the United States. This is of particular concern, since the medical establishments of all the other countries of the developed world have abandoned this procedure as having dubious benefits. This article examines the medical pros and cons of neonatal male circumcision in a historical perspective and suggests that the circumstances that led to its establishment as a routine practice are largely absent today. Reasons for its continued use and ethical and moral issues associated with its practice are then examined closely, especially in light of the current debate surrounding female circumcision. The article concludes that the medical and ethical issues surrounding this practice should be more broadly debated until there is some consensus as to its benefits. Prudence dictates that until such a consensus emerges, the practice should be suspended.

Infant circumcision: the last stand for the dead dogma of parental (sovereignal) rights

“…Tellingly, the AAP does not even attempt to argue that the available medical evidence concerning the possible benefits of circumcision constitutes sufficient ethical justification for the procedure. Instead, the AAP, as it did in 1999,54 simply passes the buck and the authority to parents, throwing in a facile reference to the ‘best interests’ of the child just for good measure 55. The 2012 report concludes:

In cases such as the decision to perform a circumcision in the newborn period (where there is reasonable disagreement about the balance between medical benefits and harms, where there are nonmedical benefits and harms that can result from a decision on whether to perform the procedure, and where the procedure is not essential to the child's immediate well-being), the parents should determine what is in the best interest of the child 47

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Circumcision: An Informed Choice

“…Circumcision has been practiced for centuries in many cultures around the world and is continued by many groups today as a religious or ethnic rite. The roots of clinical circumcision are modern; it began in the U.S. at the turn of the 20th century, when a doctor successfully removed the foreskin of a young boy suffering from what is now known as phimosis (a condition resulting from a tight foreskin that is extremely painful) (Dritsas, 2001).…”

“…Circumcision was also touted as an antidote to masturbation and became very popular both in this country and in the United Kingdom as a result. But the most important reason for circumcision's popularity in the mid-20th century was aimed not at boys who were just entering puberty, but at older males: Soldiers were routinely circumcised upon being conscripted into the armies of the U.S. and the United Kingdom, as the practice was thought to be more hygienic, as well as helpful for limiting masturbation and preventing phimosis (Dritsas, 2001;Wallerstein, 1985).…”

“…Today, rates of circumcision vary widely around the world. England, which had one of the highest rates before World War II, now counts about 1 percent of its boys as circumcised outside of religious practice (Dritsas, 2001). This significant reduction in prevalence is due to the decision in the early 1950s, by the British National Health Service, not to cover routine infant circumcision (Milos & Macris, 1992).…”

Circumcision and newborn utis: Winberg's solution

“…As an alternative to circumcision to prevent early infantile male UTI, more natural colonization could be promoted by strict rooming‐in of mother and baby or by active colonization of the baby with his mother's anaerobic gut flora' [1]. Other authors [2–4] highlighted this proposal, but the views were published in either an English review [2] or in relatively obscure American or French publications [3,4]. Winberg's proposal has not been properly considered in the USA; it was not even cited in the last policy statement of the American Academy of Pediatricians [5], which seems to be reticent on this major scientific issue.…”