Circumcision does not alter long-term glucocorticoids accumulation or psychological effects associated with trauma- and stressor-related disorders

Abstract

Male infants and boys through early adolescence can undergo circumcision either for the sake of upholding religious traditions or for medical reasons. According to both, Jewish as well as Islamic tenets, circumcision is a religious rite symbolizing the bond with God. The World Health Organization (WHO), the United Nations Council (UNC) as well as the American Academy of Pediatrics (AAP), and the Centers for Disease Control and Prevention (CDC) strongly recommend circumcision to promote hygiene and prevent disease. This procedure has frequently been criticized by various communities claiming that circumcision in infancy and early adolescence were psychologically traumatizing with medical implications up into old age. Due to the lack of evidence concerning an alleged increase in vulnerability, we measured objective and subjective stress and trauma markers, including glucocorticoids from hair samples, in circumcised and non-circumcised males. We found no differences in long-term limbic–hypothalamic–pituitary–adrenal axis activity, subjective stress perception, anxiety, depressiveness, physical complaints, sense of coherence and resilience. Rather, an increase in the glucocorticoid levels indicated a healthy lifestyle and appropriate functioning. Thus, our findings provide evidence that male circumcision does not promote psychological trauma. Moreover, a qualitative approach, the ambivalence construct, was used for the discussion, aiming at a discourse devoid of biases.

Critical evaluation of arguments opposing male circumcision: A systematic review

“…87 A study of 20 Jewish males in Dresden, Germany found that MC did not alter long-term limbic-hypothalamic-pituitary-adrenal axis activity, subjective stress perception, anxiety, depressiveness, physical complaints, sense of coherence, and resilience. 88 Rather, the study found that an increase in the glucocorticoid levels indicated a healthy lifestyle and appropriate functioning, concluding that the study provided evidence that MC does not promote psychological trauma. An MC opponent commented that the study was underpowered.…”

“…The mother was strongly opposed to MC, leading critics to question her approval for this experiment and an assertion that the online report, by an MC opponent, was a fabrication . A study of 20 Jewish males in Dresden, Germany found that MC did not alter long‐term limbic‐hypothalamic‐pituitary‐adrenal axis activity, subjective stress perception, anxiety, depressiveness, physical complaints, sense of coherence, and resilience . Rather, the study found that an increase in the glucocorticoid levels indicated a healthy lifestyle and appropriate functioning, concluding that the study provided evidence that MC does not promote psychological trauma.…”

Critical Evaluation of a Survey Claiming “Long-Term Adverse Outcomes from Neonatal Circumcision”*

“…Infants remember NMC pain only when no anesthesia is used, leading to anesthesia being recommended Taddio et al [133] No evidence of lasting brain changes, nor psychological trauma in neonatally circumcised men Ullmann et al [171] No psychological problems among Swedish schoolboys circumcised for phimosis, apart from "shyness and unwillingness to undress in school gym" Stenram et al [173] [174]…”

Proving a negative? Methodological, statistical, and psychometric flaws in Ullmann et al. (2017) PTSD study

“…Examination by the present author of both the 95% and 99% CIs reveals that the confidence intervals for the 30-item Perceived Stress Questionnaire scores (with only 7 circumcised men included since two PSQ response forms were incomplete; see Ullmann et al, Table 2) were unacceptably wide, showing that the mean PSQ scores reported were unreliable. The respective confidence intervals are as follows: Since Ullmann et al stated that, "The PSQ meets the highest national and international quality standards" [1], one can only conclude that the sample size of 7 circumcised men was completely inadequate to obtain reliable PSQ scores. How many of these men had undergone circumcision without analgesia and how many with it?…”

“…Yet as will be demonstrated, it is neither logically nor statistically sound to draw any such conclusions on the basis of a null finding [2][3][4], especially when this finding is derived from an underpowered cross-sectional study in which the trend in the data suggest, if anything, that an adequately powered study may have shown exactly the opposite of what the authors claimed [5]. Indeed, as Ullmann et al themselves reported [1].…”