24 November 2010

The Circumcision Debate

So lately I've been talking to friends about the proposed circumcision ban in San Francisco.  I have to admit to being a little torn on it.  I'm absolutely against routine infant circumcision, but I also am unsure of a ban, since it is an important religious rite for Jews and at least some Muslims (I'm not as sure about the teachings for it in Islam).  So I don't really think it can be banned outright and still allow for religious freedom.

What I think would be a better way to go about it is to have insurance companies stop paying for it, personally.  I'm in England, and the NHS don't pay for routine, non-therapeutic circumcision.  Obviously if there's a medical indication for circumcising, they will do it, but not otherwise.  I don't know if private doctors here circumcise, as I've never looked into it.  Those circumcising for religious reasons can, of course, find a mohel.

Now, in case you're wondering why I'm against routine infant circumcision, it's because it's unnecessary.  The chances of an infant boy getting recurrent UTIs, a case when circumcision has been advised by some, is slim and doesn't justify routinely circumcising all boys.  I also wonder if the UTI rate isn't perhaps more related to feeding practices than circumcision, from what little I've read on the matter.  It's also not difficult to care for an intact boy - the only thing is making sure no one tries to retract the foreskin, which is non-issue here in England since routine circumcision isn't done.  Other health issues, such as penile cancer, are also extremely rare and, in my opinion, don't warrant the pain and risks of routinely circumcising all boys, sometimes without adequate pain relief.  Not to mention that circumcision can (though doesn't always, of course) adversely affect the breastfeeding relationship - there are conflicting studies on this, though.

While not exactly a forceful statement, even the American Academy of Pediatrics says it's unnecessary and that the potential benefits don't outweigh the risks.  The British Medical Association is more forceful, stating that "The medical benefits previously claimed, however, have not been convincingly proven, and it is now widely accepted, including by the BMA, that this surgical procedure has medical and psychological risks. It is essential that doctors perform male circumcision only where this is demonstrably in the best interests of the child. The responsibility to demonstrate that non-therapeutic circumcision is in a particular child’s best interests falls to his parents."

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