02 July 2004

How Necessary Is It Today?

From Dr. Reynaldo Joson's Website

In the Philippine provinces, the summer months of March and April every year bring anxiety and apprehension to the hearts of young boys as this is the time when they get circumcised. Locally termed "tuli," Filipino boys (age 9 and above) are encouraged by their parents to get circumcised under the supervision of the town's foremost "albularyo" or "magtutule" who is usually an old man who uses a sharp bladed object to cut the penile foreskin. The boys are advised to chew on "bayabas" (guava) leaves which they will eventually spit on their male organs once the foreskin has been cut. This is the old-fashioned way of doing it. Those boys living in urban and suburban locations are circumcised by a doctor either in a clinic or a hospital setup.

These days, however, there is a voice of dissent heard against this practice. And it comes not from young Filipino boys but from a noted Filipino surgeon by the name of Dr. Reynaldo Joson, former head of the Department of Surgery of the Ospital ng Maynila Medical Center.

Check out his website against male circumcision and tell me what you think about it.

4 reactions:

Moof said...

This is an interesting subject, and apparently, an extremely controversial one in some places.

All of my adult sons were circumcised as newborns, and none have ever expressed their desire to have remained "uncut." My late husband, and my husband of 27 years, were both circumcised as infants, and neither of them rued it.

There is a movement in the US which would make circumcision illegal, and I feel that this would be a mistake. I believe that the choice should remain with the parents, especially when particular religions are concerned.

Also, I read that infant circumcision has been shown to prevent urinary tract infections by 90% in the first year of life. That's quite a statement.

All of that said, I feel very badly for the young men who feel forced to undergo such a procedure for cultural or masculine "image" reasons. Even more so since I've been told that it's far more painful later in life, and by then, unless there's a problem with infection, the possible medical benefit has passed.

I don't believe circumcision should be socially mandated, nor do I believe it should be legally banned. I believe it should be left up to the parents of newborns, and if they choose to forgo it, then later to the individual adults.

I do firmly believe, however, that at any age, it should never be performed without proper and adequate pain relief.

Dan Blackham said...

Moof said... "Also, I read that infant circumcision has been shown to prevent urinary tract infections by 90% in the first year of life. That's quite a statement."

That is quite a statement! What is the source?

The Royal Australasian College of Physicians does not share that opinion. The RACP says, "The Urinary tract infections affect 1%-2% of boys, and may be about 5 times less frequent in circumcised boys, whilst circumcision has a complication rate of 1% to 5%. On current evidence routine neonatal circumcision cannot be supported as a public health measure on this basis."

And the American Academy of Pediatrics does not share that opinion either. The AAP says, "More recent studies using cohort and case– control design also support an association, although reduced in magnitude. These studies have found a three to seven times increased risk of UTI in uncircumcised male infants compared with that in circumcised male infants." and "Although the relative risk of UTI in uncircumcised male infants compared with circumcised male infants is increased from 4- to as much as 10-fold during the first year of life, the absolute risk of developing a UTI in an uncircumcised male infant is low (at most, ~1%)."

Antibiotics are an effective, non-invasive way to treat UTIs in both boys and girls. Why should prophylactic surgery even be considered when the problem is rare and there are effective, non-invasive methods of treatment available? The British Medical Association says it is unethical and inappropriate to use surgery to treat a medical condition that can be treated effectively by non-invasive methods. "Unnecessarily invasive procedures should not be used where alternative, less invasive techniques, are equally efficient and available. It is important that doctors keep up to date and ensure that any decisions to undertake an invasive procedure are based on the best available evidence. Therefore, to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate."

Dan Blackham said...

I do not know how anyone could look at the photo at the top of the page and not conclude that it is an example of violent sexual abuse of a child.

Would it be less of a violation of the child's basic human rights if the person doing the cutting were a doctor and it were being done in a hospital?

Approximately one third of the girls circumcised in Egypt are now circumcised by doctors. If female genital cutting is done by a doctor in a hospital, is it less of a violation of the girl's basic human rights?

If it is abuse to forcibly restrain a nine year old boy and cut off a normal, healthy part of his penis against his will and without a valid medical indication, at what age does forcibly restraining a boy and cutting off a normal, healthy part of his penis against his will and without a valid medical indication change from abuse into an acceptable cultural or religious practice?

It appears that elective, non-therapeutic circumcision of boys is the only exception to the normal standard of care that is used for all other pediatric surgery. Is there any other surgery that doctors will perform on infants or children, that does not have a significant NET medical benefit or does not correct a congenital abnormality?

Dr. Emer said...

MOOF: As I said, most males here are circumcised and proud of it, too. Those who remain uncircumcised are the minority and are always the butt of jokes among peers. My stand is still --- respect the patient's decision --- if they want it, then have it, and if otherwise, it's ok, too.

DAN: Your arguing points are sound and I do believe them, but it will take probably years before you can change the mindset here. Tradition is culture-based and it has deep roots.