Child Circumcision: An Elephant in the Hospital

NOTE: This presentation includes some graphic slides necessary to present the procedure and anatomy being discussed.

What is infant circumcision? Why is the practice common in U.S. hospitals and not in other countries? What does it remove and how does that affect the child? Does scientific data suggest that circumcision has benefits? What are the potential complications? How does it affect sexuality? Is it a medical procedure or a social surgery? If it's unnecessary surgery, what about contemporary bioethics principles?

Through both a review of scientific literature and a discussion of the human cost of the procedure, this presentation explores these questions from the perspectives of the child, the adult survivor, the parent, and the practitioner.

Ryan McAllister, PhD, is a parent, a biophysicist, an Assistant Professor of Physics and Oncology at Georgetown University, and also a volunteer who supports parents and families. Over the last 10 years he has been studying the medicalization of childbirth in U.S. hospitals.

Today, most Americans think of circumcision as natural procedure for male babies. Neonatal circumcision is the most common operation carried out in the U.S. today. Nationally, rates are as high as 60%, down from a peak of 75% in the 1970s. But when compared to the rest of the English speaking world, America is unique. Great Britain, Canada and Australia have current rates of male circumcision at about 15%, whereas New Zealand is lower than 5%. In the US, the rate differs by regionally, with high rates of circumcision in the white South, but low circumcision rates among babies of Hispanic origin. Most of the rest of the Western world has retained the abhorrence of male circumcision that has existed in Europe since the time of the ancient Greeks (and as noted in the last post, some in 18th century England feared Jewish emancipation meant universal circumcision!). What happened in the US that made the procedure so popular?

There are a number of reasons that brought circumcision to prominence in America in the early 20th century.

1. Stop Masturbation! Advocates were aided by the puritanical moral sentiment of the day, as circumcision was promoted as a way to discourage masturbation. (Modern surveys have actually shown the opposite to be true.)

1. Circumcision as a cure for maladies. In 1870, Dr. Lewis Sayre of New York (and vice president of the newly-formed American Medical Association), examined a boy who was unable to straighten his legs and whose condition had so far defied regular treatment. Upon noting that the boys genitals were inflamed, Sayre hypothesized that chronic irritation of the boys foreskin had paralyzed his knees via reflex neurosis. Sayre circumcised the boy, and within a few weeks he recovered from his paralysis. After additional positive results, Sayre began to promote circumcision as an orthopedic remedy, and his prominence within the medical profession and the newly formed AMA allowed him to reach a wide audience. Over the next decades, the list of ailments reputed to be treatable through circumcision grew to include hernia, bladder infections, kidney stones, insomnia, rheumatism, epilepsy, asthma, erectile dysfunction, syphilis, insanity, and a handful of other syndromes.

1. Hospitals. Compounded by cause no. 1, as hospitals proliferated in urban areas, more children were under the care of physicians in hospitals rather than with midwives in the home. Some historians have even theorized that circumcision became a class marker of those wealthy enough to afford a hospital birth.

1. Easier Surgical Procedures. The discovery in 1885 of hypodermic cocaine as a local anaesthetic made it easier for doctors without expertise in the use of chloroform to perform minor surgeries. Several mechanically-aided circumcision techniques, forerunners of modern clamp-based circumcision methods, were first published in the medical literature of the 1890s, allowing surgeons to perform circumcisions more safely and successfully.

Circumcision was at a statistical height of about 75% of the country from 1950 to 1970. Today it is becoming less popular, partially because of high numbers of Hispanic immigrants, and growing opposition in the more progressive northeast and west (it remains overwhelmingly common in the South). Today, the major medical societies in the USA do not recommend routine non-therapeutic infant circumcision. This has long also been the case in the rest of the English speaking world, which has never seen circumcision rates as high as the United States.

See also

• Circumcision: Elephant in the Hospital

External links

• Ryan's website
• Video also available at Vimeo