Informed consent

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For some reason this information is not making it to parents. Studies have shown that doctors provide parents with almost no accurate or useful information about circumcision. One study showed that 40% of parents believed that their doctors failed to provide enough information, 46% reported that their doctors failed to give them any medical information at all, and 82.8% of parents regretted their decision they made within the first six months of their son’s life. [1] Another study found that physicians were less likely to circumcise their own sons. [2] This suggests that doctors are very well aware that circumcision is a non-therapeutic surgery (in short, a ritual); but they do not appear to share this knowledge with parents. A busy physician can supplement their income by as much as $60,000 per year from circumcision surgeries alone. [3] This incentive can cloud a physician’s judgment when it comes to providing parents with information about circumcision.

Horror of Circumcision.

Many parents are surprised to hear that anesthetics are used in only a minority of cases. [4] The use of local anesthetics significantly drives up the costs of surgery. When anesthetics are used, they can only reduce the pain. Infants can not be given general anesthesia because of the medical risks involved. In the recent past, anesthesia was rarely used, if ever. Because of this, circumcision has always been an extremely traumatizing experience causing an array of short and long term behavioral and developmental problems [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] , including altered perceptions of pain [16] [17] [18] , post traumatic stress disorder (PTSD) [19] [20] [21] [22] , and a possibly of adult self destructive behavior. [23] [24] [25] Many circumcised men, some of whom are doctors, experience a strong denial of loss which in turn fuels an emotional compulsion to repeat the trauma to normalize their loss. [26] [27] [28] [29] [30]

References

  1. Adler R, Ottaway S, Gould S. circumcision: We have heard from the experts; now let’s hear from the parents. Pediatrics 2001 Feb;107(2):E20
  2. Topp, S. (1978, January). Why not to circumcise your baby boy. Mothering, 6, 69-77.
  3. Fleiss, Paul M.D. What your Doctor May Not Tell You About Circumcision. Warner books. New York. Sept 2002.
  4. Stang , M.J., & Snellman, L.W. (1998). Circumcision practice patterns in the United States. Pediatrics, 101(6)
  5. Gunnar MR, Fisch RO, Korsvik S, Donhowe JM. The effects of circumcision on serum cortisol and behavior. Psychoneuroendocrinology 1981; 6(3):269-75.
  6. Porter FL, Miller RH, and Marshal RE. Neonatal pain cries: effect of circumcision on acoustic features and perceived urgency. Child Dev 1986;57:790-802.
  7. Porter, FL, Porges SW, Marshall RE. Newborn pain cries and vagal tone: parallel changes in response to circumcision. Child Dev 1988;59:495-505.
  8. Emde RN, Harmon RJ, Metcalf D, et al. Stress and neonatal sleep. Psychosom Med 1971;33(6):491-7.
  9. Gunnar MR, Connors J, Isensee, Wall L. Adrenocortical activity and behavioral distress in human newborns. Dev Psychobiol 1988;21(4):297-310.
  10. Anders TF, Chalemian RJ. The effects of circumcision on sleep-wake states in human neonates. Psychosom Med 1974;36(2):174-9.
  11. Marshall RE, Stratton WC, Moore JA, et al. Circumcision I: effects upon newborn behavior. Infant Behavior and Development 1980;3:1-14.
  12. Marshall RE, Porter FL, Rogers AG, et al. Circumcision: II effects upon mother-infant interaction. Early Hum Dev 1982; 7(4):367-74.
  13. Lee N. Circumcision and breastfeeding. J Hum Lact 2000;16(4):295.
  14. Anand KJS, Hickey PR. Pain and its effects in the human neonate and fetus. New Engl J Med 1987;317(21):1321-9. http://www.cirp.org/library/pain/anand/ Retrieved 3/21/11
  15. Anand KJS, Frank M. Scalzo. Can Adverse Neonatal Experiences Alter Brain Development and Subsequent Behavior? BIOLOGY OF THE NEONATE, Volume 77, Number 2: Pages 69-82, February 2000.http://www.cirp.org/library/pain/anand4/ Retried 3/21/11
  16. Taddio A, Goldbach M, Ipp E, et al. Effect of neonatal circumcision on pain responses during vaccination in boys. Lancet 1995;345:291-2.http://www.cirp.org/library/pain/taddio/ Retrieved 3/21/11
  17. Taddio A, Katz J, Ilersich AL, Koren G. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet 1997;349(9052):599-603.http://www.cirp.org/library/pain/taddio2/ Retrieved 3/21/11
  18. LaPrairie Jamie L. Murphy Anne Z. Neonatal Injury Alters Adult Pain Sensitivity by Increasing Opioid Tone in the Periaqueductal Gray. Front Behav Neurosci 30 September 2009. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2766783/ Retrieved 3/21/11
  19. Boyle GJ, Goldman R, Svoboda JS, Fernandez E. Male circumcision: pain, trauma and psychosexual sequelae. J Health Psychol 2002;7(3):329-43.
  20. Rhinehart J. Neonatal circumcision reconsidered. Transactional Analysis J 1999;29(3):215-21.
  21. Ramos S, Boyle GJ. Ritual and medical circumcision among Filipino boys: evidence of post-traumatic stress disorder. In: Denniston GC, Hodges FM, Milos MF (eds) Understanding circumcision: A Multi-Disciplinary Approach to a Multi-Dimensional Problem. New York: Kluwer Academic/Plenum Publishers, 2001: pp. 253-70.
  22. Menage J. Post-traumatic stress disorder in women who have undergone obstetric and/or gynaecological procedures. J Reprod Infant Psychol 1993;11:221-28.
  23. Van der Kolk BA, Perry JC, Herman JL. Childhood origins of self-destructive behavior. Am J Psychiatry 1991; 148;1665-71.
  24. Jacobson B, Bygdeman M. Obstetric care and proneness of offspring to suicide. BMJ 1998; 317:1346-49.
  25. Salk L, Lipsitt LP, Sturner WQ, et al. Relationship of maternal and perinatal conditions to eventual adolescent suicide. Lancet 1985;i:624-7.
  26. Van der Kolk BA. The compulsion to repeat the trauma: re-enactment, revictimization, and masochism. Psychiatr Clin North Am 1989;12(2):389-411.
  27. Goldman R. The psychological impact of circumcision. BJU Int 1999;83 Suppl. 1:93-103.
  28. Maguire P, Parks CM. Coping with loss: surgery and loss of body parts. BMJ 1998;316(7137):1086-8. http://www.cirp.org/library/psych/maguire/ retrieved 3/18/11
  29. Hill G. The case against circumcision. J Mens Health Gend 2007;4(3):318-23.
  30. Goldman R. Circumcision policy: a psychosocial perspective. Paediatr Child Health 2004;9(9):630-3.