Male Circumcision: A Social and Medical Misconception


University of Johns Hopkins

Introduction

Male circumcision is defined as a surgical procedure in which the prepuce
of the penis is separated from the glands and excised. (Mosby, 1986) Dating as
far back as 2800 BC, circumcision has been performed as a part of religious
ceremony, as a puberty or premarital rite, as a disciplinary measure, as a
reprieve against the toxic effects of vaginal blood, and as a mark of slavery.
(Milos & Macris, 1992) In the United States, advocacy of circumcision was
perpetuated amid the Victorian belief that circumcision served as a remedy
against the ills of masturbation and systemic disease. (Lund, 1990) The
scientific community further reinforced these beliefs by reporting the incidence
of hygiene-related urogenital disorders to be higher in uncircumcised men.
Circumcision is now a societal norm in the United States. Routine
circumcision is the most widely practiced pediatric surgery and an estimated one
to one-and-a-half million newborns, or 80 to 90 percent of the population, are
circumcised. (Lund, 1990) Despite these statistics, circumcision still remains a
topic of great debate. The medical community is examining the need for a
surgical procedure that is historically based on religious and cultural doctrine
and not of medical necessity. Possible complications of circumcision include
hemorrhage, infection, surgical trauma, and pain. (Gelbaum, 1992) Unless
absolute medical indications exist, why should male infants be exposed to these
risks? In essence, our society has perpetuated an unnecessary surgical procedure
that permanently alters a normal, healthy body part.
This paper examines the literature surrounding the debate over circumcision,
delineates the flaws that exist in the research, and discusses the nurse\'s role
in the circumcision debate.

Review of Literature

Many studies performed worldwide suggest a relationship between lack of
circumcision and urinary tract infection (UTI). In 1982, Ginsberg and McCracken
described a case series of infants five days to eight months of age hospitalized
with UTI. (Thompson, 1990) Of the total infant population hospitalized with UTI,
sixty-two were males and only three were circumcised. (Thompson, 1990) Based on
this information, the researchers speculated that, "the uncircumcised male has
an increased susceptibility to UTI." Subsequently, Wiswell and associates from
Brooke Army Hospital released a series of papers based upon a retrospective
cohort study design of children hospitalized with UTI in the first year of life.
The authors conclusions suggest a 10 to 20-fold increase in risk for UTI in the
uncircumcised male in the first year of life. (Thompson, 1990) However, Thompson
(1990) reports that in these studies analysis of the data was very crude and
there were no controls for the variables of age, race, education level, or
income. The statistical findings from further studies are equally misconstruing.
In 1986, Wiswell and Roscelli reported an increase in the number of UTIs as the
circumcision rate declined. By clearly leaving out "aberrant data", the results
of the study are again very misleading. In 1989, Herzog from Boston Children\'s
Hospital reported on a retrospective case-control study on the relationship
between the incidence of UTI and circumcision in the male infant under one year
of age. Here too, the results were not adjusted to account for the variables of
age, ethnicity, and drop-out rate of the participants. It is obvious that this
research is statistically weak and should not be the criteria on which to decide
for or against neonatal circumcision.
Lund (1990) reports that a study conducted by Parker and associates
estimates the relative risk of uncircumcised males to be double that of
circumcised males for acquiring herpes genitalis, candidiasis, gonorrhea, and
syphilis. Simonsen and coworkers performed a case-control study on 340 men in
Kenya, Africa in an attempt to explain the different pattern for acquired immune
deficiency syndrome (AIDS) virus in Africa as compared to the United States.
(Thompson, 1990) The authors conclude that the relative risk for AIDS was higher
for uncircumcised men. Results from similar studies in the United States remain
conflicting. Although most of the existing studies do associate a relationship
between the incidence of venereal disease and circumcision, the American Academy
of Pediatrics found existing reports inconclusive and conflicting in results.
(Lund, 1990) There is an overwhelming incidence of STD and AIDS in the United
States, where a majority of the men are circumcised.
It is imperative that we look at ways of altering our risk of exposure to
these agents than at altering the sexual anatomy of the healthy male. These
disease states are caused by specific pathogens and high-risk behavior, not by
the uncircumcised penis.
Clinical research clearly supports the idea that circumcision performed in
the neonate has many characteristics associated with pain.