Should the newborn male be circumcised?

The answer largely depends on who you ask and where you live.

Cultural and religious traditions are so overwhelming that only rarely is there a deviation from the accepted custom. The rite among the Jews is recorded in Genesis and is performed on the eighth day after birth. Among the Mohammedans, after the example of the founder is Islam, it may be done on the seventh day, but usually is postponed to between the seventh and 12th year. Christianity recognizes no religious significance concerning it.

In recent years, there has developed a rebellion and the long held custom is being questioned on its value. In 1983, the American Academy of Pediatrics reaffirmed an earlier opinion stating "there is no absolute indication for routine circumcision of the newborn."

But the question still lingers: Should we, or should we not.

Studies have shown, in recent years, a higher rate of urinary tract infection in boys during the first weeks of life in those not circumcised. And the major unsettled point is whether this infection leads to a scarring of the kidney that is capable of producing kidney failure and hypertension, in later years. If so, that is big business. And the final answer must be pursued.

In the United States, 1 million circumcisions are performed yearly, but the frequency is dropping to 70%, from the past high of 90%. A similar decline is occurring in Canada. It is not common in Europe and has been all but abandoned in Great Britain. Both sides of the controversy are adamant in their beliefs.

In a conflict such as this, who must step forward and make the bold decision? In my experience, all, but a dozen or so, newborn males were circumcised out of the hundreds I delivered. I was firm in my conviction that it was beneficial to the health of the child and the new studies seem to strengthen that position.

When an infant is born in our society, usually the parents, who even with the advantage of sex determination through ultrasound before birth, have not discussed the issue in great depth. Often, the grandparents play a part in the decision, or, more important still, what did or did not happen to the father in this matter is the ultimate guidance. The physician always brings up the issue, and it usually is his policy to educate, but not advise. Since mothers are discharged from the hospital in a matter of hours nowadays, the moment of decision is abrupt and it is final.

The act of circumcising is not a very complicated procedure, yet it must be done with expert competence, under sterile conditions, to avoid minor and major complications of bleeding, infection, urinary damage and disfigurement. Thankfully, it doesn't take long, and the mother is tucked safely in her room, away from the experience.

Factors favoring routine newborn circumcision include:

1. There is a 20 times increase in early urinary infection in the uncircumcised.

2. Of the 60,000 cases of penile cancer in the U.S. since 1930, there only have been 10 cases in the uncircumcised.

3. The risk of HIV is eight times greater in the uncircumcised.

4. The prevalence of syphilis, gonorrhea and herpes is two to five times greater in the uncircumcised.

5. If the procedure is needed later in life, it is much, much more costly and disabling.

Factors against early circumcision include:

1. There is no absolute proof, at this time, that permanent kidney damage results from early urinary infection.

2. As in most all procedures, mistakes can be made and results can be less than perfect. If it isn't broken, don't fix it.

3. Cancer of the penis is rare: only one in 600.

4. Infection, scarring and hemorrhage can occur, even in the best hands.

5. There is an unproved lessening of sexual response in those circumcised.

The matter is certainly in the hands of the parents. They must give more than momentary consideration to the issue. The infant only is an unwilling bystander.

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