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
