Ignore the Myths, Get the Facts
The following cultural beliefs, or myths, are often used as reasons for circumcision. After each myth, some relevant facts are provided to present a more accurate picture of this procedure. Parents should understand the full implications of circumcision before making this irreversible decision for their child.
Myth #1: Circumcision is recommended by doctors and medical organizations
Fact: Circumcision is not recommended by any national medical association in the world. Fifteen national and international medical associations have extensively studied infant circumcision and its effects and found no significant evidence to support this practice. In March 1999, the American Academy of Pediatrics (AAP) concluded that infant circumcision is not recommended as a routine procedure.1 The circumcision policy statements of the American Medical Association (AMA) and the American Academy of Family Physicians have concurred with this position.2-3 The AMA calls infant circumcision “non-therapeutic.”
Myth #2: It’s just a little piece of skin, he won’t miss it.
Fact: The prepuce (foreskin) makes up as much as half of the skin system of the penis.4 It is an extension of the shaft skin that folds over onto itself, completely covering and protecting the glans (an internal organ) and provides the mobility of the shaft skin necessary for frictionless intercourse and masturbation. The foreskin has three known functions: protective, immunological, and sexual. It contains about 10,000 highly specialized nerve endings and several feet of blood vessels. An adult male foreskin, if unfolded and spread out, would be about the size of index card (3 x 5 inches), much more than a “little piece of skin.” Many sexually active men circumcised in adulthood report a significant decrease in sexual pleasure and comfort because of the loss of sensitive nerve endings, skin mobility and natural lubrication.
Myth #3: The care of a circumcised penis is easier than an intact penis.
Fact: For the care of an intact penis, the AAP recommends, “Leave it alone.” 5 No special care is required – an intact child should have the external surface of his penis (and the rest of his body) washed regularly to keep clean. When a male is older and can retract his foreskin (which typically occurs by puberty), a simple rinsing is all that is necessary. 6 Other cultural myths about special cleaning procedures are just that – myth.
Myth #4: Circumcision protects males from urinary tract infections.
Fact: Overall, urinary tract infections (UTI) occur at about the same rate in male and female infants during the first six months of life.7 Regardless of circumcision status, infants who present with their first UTI at 6 months (or less) are likely to have an underlying genitouninary abnormality. In children with a normal underlying anatomy, a study found as many circumcised infants with a UTI as those who retained their foreskin.8 The appropriate treatment for UTI, in males as well as females, is antibiotics, not prophylactic excision of the prepuce. According to the AAP, “Urinary tract infections are usually not life threatening and are easily treated in most cases.” Breastfeeding provides some measure of protection against UTI during the first six months of life.9
Myth #5: Circumcision is effective in the prevention of penile cancer.
Fact: “The American Cancer Society does not consider routine circumcision to be a valid or effective measure to prevent such cancers... Penile cancer is an extremely rare condition, affecting one in 200,000 men... Perpetrating the mistaken belief that circumcision prevents cancer is inappropriate.’’ 10
The American Medical Association, in a July 2000 report, states, “… because this disease [penile cancer] is rare and occurs later in life, the use of circumcision as a preventive practice is not justified.” 2
Myth #6: Almost everyone is circumcised…I don’t want my son to be teased in the locker room.
Fact: The circumcision rate for males worldwide is about 15%. Even in the US, the only country that circumcises a majority of its male newborns for non-religious reasons, the circumcision rate is decreasing. According the National Center for Health Statistics, the US circumcision rate is approximately 60% (varies widely by region) and slowly decreasing. According to many intact males, the “teasing” concern is vastly overstated. For many boys, genital status is neither an important issue nor one that is discussed. In the unlikely event of concerns later in life, at least the person can make his own decision about an irreversible body alteration that has no medical justification.
Myth #7: Circumcision is a simple and painless procedure… it only takes a few minutes.
Fact: While circumcision is a relatively quick procedure, it is extremely painful for the infant. The initial part of the process involves a forced separation of the foreskin, which is fused to the glans (head) in much the same way as a fingernail is joined to the finger. The AAP says the following about EMLA cream, one of the most common pain relief methods, “The analgesic effect is limited during the phases associated with extensive tissue trauma…” 1 Although they cannot remember the pain as adults, circumcised male infants have increased pain response in vaccinations 4 to 6 months later.11 Circumcision appears to lower the pain threshold.
Myth #8: Circumcision makes the penis cleaner and more hygienic.
Fact: Circumcision removes the protective portion of mobile shaft skin, which is intended to cover the glans (head) of the penis. The glans is the internal portion of genitalia (for both genders). Circumcision artificially exposes and denudes this highly sensitive tissue, resulting in a buildup of keratin and a dry, densensitized part of the penis. And contrary to popular myth, more sensation does not lead tp control problems. Based on reports from men circumcised as adults, just the opposite is true. With more sensation, a man has better feedback and can better determine his proximity to the “orgasmic threshold.”
Myth #9: Circumcision prevents AIDS and other sexually transmitted diseases (STDs).
Fact: Some studies show that circumcision has a slight preventive effect for AIDS and some STDs; however, other studies show an insignificant or opposite effect, especially for chlamydia. The bottom line: sexual practices have a much greater effect on the chance of becoming infected than circumcision status. If someone acts on the misconception that circumcision alone will protect them, they are taking unwise chances.
Myth #10: The history of non-religious circumcision is based on disease prevention.
Fact: Non-ritual circumcision evolved from a misunderstanding of bodily function by physicians of the late-19th century.12 Many doctors of that era believed that a normal foreskin could cause disease and lead to increased incidence of “self-abuse.” John Harvey Kellogg, of cereal fame, was a proponent of genital cutting as a cure for this “horrible practice.” He recommended performing circumcision “without administering an anesthetic, as the pain attending the operation will have a salutary [health-giving] effect upon the mind, especially if connected with the idea of punishment.”
This fact sheet is a presentation of the Pennsylvania chapter of NOCIRC (National Organization of Circumcision Information Resource Centers).
References:
1. American Academy of Pediatrics, Circumcision Policy Statement - March 1, 1999
2. American Medical Association, Report 10 of the Council on Scientific Affairs (I-99), July 6, 2000
3. American Academy of Family Physicians, Position Paper on Neonatal Circumcision, February 14, 2002
4. Cold CJ, Taylor J. The prepuce. BJU Int 1999; 83:34-44
5. American Academy of Pediatrics pamphlet. Newborns: Care of the Uncircumcised Penis – Guidelines for Parents. 1990
6. CIRP: Normal development of the prepuce: Birth through age 18. www.cirp.org/library/normal/
7. Marild S, Jodal U. Incidence rate of symptomatic urinary tract infection in children under 6 years of age. Acta Paediatrica 1998;87:549-52
8. Mueller E, Steinhardt G, Naseer S. The Incidence of Genitourinary Abnormalities in Circumcised and Uncircumcised Boys Presenting with an Initial Urinary Tract Infection by 6 Months of Age. Pediatrics 1997;100(supplement):580
9. Pisacane A, Graziano L, Mazzarella G, Scarpellino B, Zona G. Breast-feeding and urinary tract infection. Pediatrics 1992;120:87-89
10. Letter from the American Cancer Society (National Home Office) to the American Academy of Pediatrics, 16 Feb 1996
11. Taddio A, Katz J, Ilersich A, Koren G. Effect of Neonatal Circumcision on Pain Response During Subsequent Routine Vaccination. Lancet 1997;349:599-603.
12. Gollaher D. Circumcision: A History of the World’s Most Controversial Surgery, New York, Basic Books, 2000
Looks like your MythBusting days are over, perhaps YOU need to get the FACTS:
“It is now up to state governments to ensure that bans on elective infant male circumcision in public hospitals are lifted without delay. And it is essential that the federal government revises the Medicare rebate so that this procedure is affordable for low-income families.
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Medical researchers recommend male circumcision
March 2, 2012 in Health
Penile cancer, HIV, HPV, syphilis and kidney inflammation are among a number of medical conditions whose risk can be lowered by the practice of infant male circumcision, says a study led by the University of Sydney.
“The costs saved will be enormous, as this policy statement shows that half of uncircumcised males will suffer an adverse medical condition over their lifetime, and many will die as a result of diseases preventable by circumcision,” Professor Morris said.
http://medicalxpress.com/news/2012-03-medical-male-circumcision.html
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AMERICAN ACADEMY OF PEDIATRICS
Report of the Task Force on Circumcision
AAP TASK FORCE ON CIRCUMCISION
Abstract
Properly performed newborn circumcision prevents phimosis, paraphimosis, and balanoposthitis and has been shown to decrease the incidence of cancer of the penis among US men. It may result in a decreased incidence of urinary tract infection. However, in the absence of well-designed prospective studies, conclusions regarding the relationship of urinary tract infection to circumcision are tentative. An increased incidence of cancer of the cervix has been found in sexual partners of uncircumcised men infected with human papillomavirus. Evidence concerning the association of sexually transmitted diseases and circumcision is conflicting.
Newborn circumcision is a rapid and generally safe procedure when performed by an experienced operator. It is an elective procedure to be performed only if an infant is stable and healthy. Infants respond to the procedure with transient behavioral and physiologic changes.
Local anesthesia (dorsal penile nerve block) may reduce the observed physiologic response to newborn circumcision. It also has its own inherent risks. However, reports of extensive experience or follow-up with the technique in newborns are lacking.
Newborn circumcision has potential medical benefits and advantages as well as disadvantages and risks. When circumcision is being considered, the benefits and risks should be explained to the parents and informed consent obtained.
Copyright © 1989 by the American Academy of Pediatrics
http://pediatrics.aappublications.org/content/84/2/388.abstract?ijkey=506c5aa42922b638173653f480821c7d7cc80531&keytype2=tf_ipsecsha
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WHO and UNAIDS announce recommendations from expert consultation on male circumcision for HIV prevention
28 March 2007 | Paris/Geneva -In response to the urgent need to reduce the number of new HIV infections globally, WHO and the UNAIDS Secretariat convened an international expert consultation to determine whether male circumcision should be recommended for the prevention of HIV infection.
Based on the evidence presented, which was considered to be compelling, experts attending the consultation recommended that male circumcision now be recognized as an additional important intervention to reduce the risk of heterosexually acquired HIV infection in men. The international consultation, which was held 6-8 March 2007 in Montreux, Switzerland, was attended by participants representing a wide range of stakeholders, including governments, civil society, researchers, human rights and women’s health advocates, young people, funding agencies and implementing partners.
“The recommendations represent a significant step forward in HIV prevention,” said Dr Kevin De Cock, Director, HIV/AIDS Department in WHO. “Countries with high rates of heterosexual HIV infection and low rates of male circumcision now have an additional intervention which can reduce the risk of HIV infection in heterosexual men. Scaling up male circumcision in such countries will result in immediate benefit to individuals. However, it will be a number of years before we can expect to see an impact on the epidemic from such investment.”
http://www.who.int/mediacentre/news/releases/2007/pr10/en/index.html
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New Studies Sharpen Circumcision Debate
But complicating the debate now are recent studies that do show some medical benefits: Circumcised men have a lower risk of getting HIV and other sexually transmitted diseases. The procedure also reduces the risk of urinary tract infections in infants by 90% and the risk of penile cancer in older men by 50% or more. Both conditions are quite rare in this country.
http://www.webmd.com/parenting/baby/features/new-studies-sharpen-circumcision-debate
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Demand for male circumcision rising in Rwanda
It has been scientifically proven that a circumcised man has up to 60 percent chances of not contracting HIV during sexual intercourse.
http://allafrica.com/stories/201202200020.html
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Vol.2 No.1, February 2012
Infant male circumcision: An evidence-based policy statement
Full Text(PDF, 125KB) PP.79-92 DOI: 10.4236/ojpm.2012.21012
MC provides strong protection against: urinary tract infections and, in infancy, renal parenchymal disease; phimosis; paraphimosis; balanoposthitis; foreskin tearing; some heterosexually transmitted infections including HPV, HSV-2, trichomonas, HIV, and genital ulcer disease; thrush; inferior hygiene; penile cancer and possibly prostate cancer. In women, circumcision of the male partner protects against HPV, HSV-2, cervical cancer, bacterial vaginosis, and possibly Chlamydia. MC has no adverse effect on sexual function, sensitivity, penile sensation or satisfaction and may enhance the male sexual experience. Adverse effects are uncommon (<1%), and virtually all are minor and easily treated.
http://www.scirp.org/journal/PaperInformation.aspx?paperID=17415
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ANRS-12126—Impact of Male Circumcision Roll-out on HSV-2 Prevalence among Men: Orange Farm, South Africa
Bertran Auvert*1,2,3, A Blake3, V Maseko4, P Lissouba2, D Lewis4, and D Taljaard5
Conclusions: This study shows that the roll-out of male circumcision can have a significantly reducing short-term impact on the spread of HSV-2 among men.
http://www.retroconference.org/2012b/Abstracts/43579.htm
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Circumcision Tied to Drop in Herpes, Too
By Ed Susman, Contributing Writer, MedPage Today
Published: March 06, 2012
Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania
“We don’t hear enough about the long-term benefits at the population level from circumcision. This is really important news that confirms what we have learned in the past about [circumcision’s] effect in reducing HIV infection, but also [shows] that it is a multipurpose technology that is ... preventing HSV-2. The fact that it is doing so much for men in preventing HIV and other infections is a story that is not being told enough.”
http://www.medpagetoday.com/MeetingCoverage/CROI/31507
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Male circumcision for HIV prevention: What does the scientific evidence say?
There is overwhelming evidence to prove that male circumcision provides other benefits beyond HIV prevention. Male circumcision improves male hygiene, reduces risk of genital ulcer disease and cancer of the penis, and lowers the risk of cervical cancer among women with circumcised male partners by reducing the prevalence of the virus that is associated with this cancer (Human Papilloma Virus).
http://www.monitor.co.ug/artsculture/Reviews/-/691232/1384560/-/dg3bb/-/index.html
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The case for neonatal circumcision
Published by Amy Tuteur, MD under Science and Medicine
The World Health Organization/Joint United Nations Program on HIV/AIDS has concluded that “the research evidence that male circumcision is efficacious in reducing sexual transmission of HIV from women to men is compelling … and has been proven beyond reasonable doubt.” In 2007, the American Urological Association revised their policy to state that “circumcision should be presented as an option for health benefits.” However, the AAP, American College of Obstetricians and Gynecologists, and American Medical Association are likely to have the greatest influence on parental decisions and insurance coverage for neonatal circumcision in the United States. With the mounting evidence that male circumcision decreases viral STIs, genital ulcer disease, and penile inflammatory disorders in men, and bacterial vaginosis, T vaginalis infection, and genital ulcer disease in their female partners, it is time for the AAP policy to fully reflect these current data.
http://www.sciencebasedmedicine.org/index.php/the-case-for-neonatal-circumcision/