Comments on Bunk: A CUT BELOW Clearly, for some parents, circumcisi...

Parents who think it is simply right to make such ...

2007-06-19T22:13:00.000-07:00

Parents who think it is simply right to make such a decision for their baby need to realize that if, after growing up, their son wants to be intact, he faces an impossible-to-change future.

Contrast with facing a more painful and difficult procedure if he does want one. That's precisely why in medical decision-making terms, it's a tie.

That is simply irrational . . . A reduction or loss is not relevant to one who has no memory of having a left arm.

Okay, if we're going to try to stay rational, I'd try to avoid the camel's-nose-under-the-tent approach to comparative anatomy and would simply state that, in the rest of the world which is not penis-obsessed, the foreskin is not considered as important as, say, an arm.

The real issue being debated here is whether parents have a right to make this decision for their children. That's perhaps a civil rights issue, beyond the scope of my purpose (exploding medical myths). As I've already stated that they make much more weighty decisions all the time, so for me the subject is moot. (And, yes, parents do make other cosmetic surgery decisions for their dependent children.)

For doctors, the issue here is not how to obtain consent from an infant but rather how to properly inform the consenting parents. I would tell parents that circumcision is (1) not necessary for the future health of their son; (2) has a small risk of bleeding, infection, or unintended disfigurement; (3) causes temporary pain; (4) removes a sensitive area of the penis; (5) overall does not affect sexual or urinary function; (6) may decrease the transmission of HIV and HPV; (6) may decrease risk of penile cancer (which is rare, anyway). Medically, there is neither a compelling reason to do a circumcision on an infant, nor is there a compelling reason to dissuade parents who desire it for their son.

Parents who think it is simply wrong to make such ...

2007-06-18T10:40:00.000-07:00

Parents who think it is simply wrong to make such a decision for their baby need to realize that if, after growing up, their son wants to be circumcised, he faces a much more difficult and painful operation.

This gets to the heart of the error in your analysis, which anonymous seems to have also brought out. Ethics matter. You're saying medically it's a tie. Fine. Then you offer the statement above. It conforms closely with what Americans think, but it's woefully incomplete.

Parents who think it is simply right to make such a decision for their baby need to realize that if, after growing up, their son wants to be intact, he faces an impossible-to-change future.

A reduction or loss is not relevant to one who has no memory of having a foreskin. To presume that he would be missing the erogenous potential of a foreskin is highly speculative.

That is simply irrational. It's a selective abuse of logic designed to justify a desired outcome. A reduction or loss is not relevant to one who has no memory of having a left arm. To presume that he would be missing the functional potential of a left arm is highly speculative.

Of course, you'll challenge that by saying that we know a left arm is functional, so we can safely assume he'd miss it. But how many millions of men around the world live normal, healthy lives with a foreskin? How many choose to voluntarily undergo the procedure, absent any medical need? There are some, but that number is in no way convincing. Sort of like phimosis being "not uncommon", if you consider 1 in 1000 not uncommon.

I could also just as easily argue, in bold italics, that no one remembers the pain of [insert dubious medical procedure] as a baby, and pretend that it's a compelling argument. Ethically, an adult can choose to have circumcision. As you point out, not all medical problems with the foreskin need to be solved by cutting it off. So an adult gets to decide when something is wrong, but a baby doesn't get to decide when there isn't anything wrong, as long as his parents approve for their own reasons? No.

In medical practice, it is not unethical to perform a procedure which causes no harm as long as the patient or patient's advocate desires it. Is all plastic surgery unethical?

Plastic surgery is perfectly ethical if the person whose body will be altered is consenting. Do I have the right to consent (safe euphemism for force) to a rhinoplasty for my kid if I don't like the shape of his nose? Breast augmentation for my teenage daughter if I think her breasts aren't large enough to fit in with society? I hope you would say no.

Which leaves us with the notion of harm. Your argument simply assumes that American medicine wouldn't do this if it caused harm. No evidence exists, etc. Fine, but simple logic tells us that there are nerve endings in the foreskin. Removing them causes harm. The foreskin developed through evolution in all mammals, so we can also assume it has a functional purpose. Removing it causes harm. We can argue how much harm, because it's subjective.

Precisely because it's subjective is why we shouldn't be performing such medically unnecessary cosmetic surgery on infants. He might have a different opinion. If left intact, statistics tell us that he probably will choose to stay intact. Your opinion of parental "rights" is flawed. Societal opinion is irrelevant when dealing with the removal of healthy, functioning body parts on an individual.

Thanks for reading. And the debate rages on . . ....

2007-06-17T06:31:00.000-07:00

Thanks for reading.
And the debate rages on . . .

Reduced and lost sensation to circumcision is not "speculative."

A reduction or loss is not relevant to one who has no memory of having a foreskin. To presume that he would be missing the erogenous potential of a foreskin is highly speculative.

Notwithstanding the article in BJU (I hope to read the whole report and maybe comment on it soon), in my practice, examining (by touching) penises elicits no different response from men with foreskins than men without. Again, the anatomical innervation of the foreskin is not overly abundant (as opposed to the urethral opening [meatus]).

The important point of whether one needs the sensitivity of a foreskin is whether it makes any difference in sexual function. There is no conclusive data to support that theory. Adult men who have painful phimosis seem to gladly make the trade, in which case circumcision is done to improve sexual function.

If it's a "tie" on medical grounds . . . then circumcising an infant is unethical.

In medical practice, it is not unethical to perform a procedure which causes no harm as long as the patient or patient's advocate desires it. Is all plastic surgery unethical?

Reduced and lost sensation to circumcision is not ...

2007-06-15T11:00:00.000-07:00

Reduced and lost sensation to circumcision is not "speculative." The foreskin is highly sensitive. Anybody who has one knows that. For those without the equipment to know this first-hand (so to speak), there's this study (abstract,pdf).

Remember... it's not just a question of whether removing the foreskin causes what remains to become less sensitive. The foreskin is erogenous tissue, sensitive both sexually and otherwise!!

Circumcision is sexual reduction surgery. That's a choice everyone deserves to make, for themselves.

Circumcision is the last holdout of the pre-scientific mindset lurking in the halls of medicine. Our grandfathers were circumcised, so we grandfather-in this procedure, even though there is no other body part we would ever cut off a child when almost everyone agrees it's completely unnecessary, take it or leave it, chosen (but not self-chosen) for culture or custom or aesthetics or religion or habit or fear or pressure!

If it's a "tie" on medical grounds (and that's generous), then circumcising an infant is unethical. In medicine, if a surgery is a "tie", that means it's not medicine, it's bunk!