Friday, July 20, 2018
Health

Parents: Educate yourselves on circumcision

A 2016 study published in Population Health Metrics estimates that roughly 39 percent of men worldwide are circumcised. Male circumcision is the removal of the foreskin from the penis. The highest rates of circumcision are in the Middle East, parts of Africa, the United States and Canada. In Europe, Latin America and southern Asia, circumcision is relatively rare. A study published online in Mayo Clinic Proceedings reported that the circumcision rate in the United States declined from 83 percent in the 1960s to 77 percent in 2010. According to the Centers for Disease Control and Prevention, the overall rate of circumcision among U.S. males age 14 to 59 is 81 percent. If parents decide to have their baby circumcised in the hospital, their pediatrician, family doctor or obstetrician will perform the procedure before they bring the baby home.

The World Health Organization recommends circumcision as a means of reducing global rates of HIV. The American Academy of Pediatrics issued this Circumcision Policy Statement in 2012: "Evaluation of current evidence indicates that the health benefits of newborn circumcision outweigh the risks and that the procedure's benefits justify access to this procedure for families who choose it. Specific benefits identified included prevention of urinary tract infections, penile cancer, and transmission of some sexually transmitted infections, including HIV." The American Medical Association and the American College of Obstetricians and Gynecologists support this statement. Also in 2012, the American Urological Association issued this statement: "The AUA believes that neonatal circumcision has potential medical benefits and advantages as well as disadvantages and risks. … When circumcision is being discussed with parents and informed consent obtained, medical benefits and risks, and ethnic, cultural, religious and individual preferences should be considered. The risk and disadvantages of circumcision are encountered early whereas the advantages and benefits are prospective."

Despite these policy statements, circumcision remains controversial. In 1996, the Canadian Pediatric Society said this about routine neonatal circumcision: "The overall evidence of the benefits and harms of circumcision is so evenly balanced that it does not support recommending circumcision as a routine practice for newborns." There can be complications resulting from the procedure, such as inadequate skin removal, infection, urethral complications, glans injury, removal of too much skin and cyst formation.

The foreskin lubricates and protects the part of the penis known as the glans penis. It has two layers: an outer layer and an inner layer. The inner layer has thousands of nerve endings and is very sensitive to touch, similar to your lips and fingertips. A study published in the Journal of Urology found that men who were circumcised later in life reported decreased penile sensitivity after the procedure.

Some men who have been circumcised experience negative psychological effects, including feeling as if they are not whole because their foreskin has been removed. There are support groups for men who believe they have been psychologically impacted by their circumcision, such as the National Organization for Restoring Men. Many men in these groups think circumcision is a human rights violation and that male infants should be protected from the procedure.

In November 2011, San Francisco attempted to pass a ban on circumcision. The ban would have made it illegal to "circumcise, excise, cut or mutilate the whole or any part of the foreskin, testicles or penis of another person who has not attained the age of 18 years." A person performing a circumcision would have faced a misdemeanor charge and a fine of up to $1,000 or a maximum of one year in prison. The measure was removed from the 2011 ballot because it would have violated California's law, which states that medical procedures are regulated by the state, not individual cities. There has been a call to ban circumcisions for nonmedical reasons for boys under the age of 12 in Denmark and Sweden, and many other countries are questioning whether circumcisions for nonmedical purposes should remain legal.

In the United States, parents generally do not have much information on circumcision before deciding whether the procedure should be performed on their sons. Many parents choose circumcision so their son looks like his father. Others opt to circumcise to adhere to cultural or religious norms. Many believe circumcision is necessary for hygienic reasons. It is important to note that proper hygiene could protect men from contracting HIV or other sexually transmitted infections in countries where soap and running water are readily accessible. Regardless of the reason, it is important that parents educate themselves on the pros and cons of circumcision before choosing it for their son. Parents should speak with their OB/GYN or family physician before consenting to a circumcision.

Dr. Katie Schubert has master's and doctorate degrees in sociology and gender studies from the University of Florida and a master's degree in clinical mental health counseling from Adams State University in Colorado. She completed her postgraduate studies at Florida Postgraduate Sex Therapy Training Institute and is a certified sex therapist, providing therapy to individuals, couples and families on issues related to sexuality, sex and gender in St. Petersburg. Contact her at drkatieschubert.com.

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