Don't Be Scared to Circumcise Your Baby Boy

It's not mutilation; it should be the parents' choice.

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I wouldn't discourage anyone from discussing and even questioning the merits of infant male circumcision. But it's a bit much to claim that the 2 million or more parents in this country who have their infant sons circumcised each year—and the thousands of doctors and hospitals that enable the procedure—are guilty of child abuse and genital mutilation. Yet that's the heart of a debate in the December 7 issue of the British Medical Journal, in which head-to-head columns respond yea and nay to the somewhat pointed question: "Is infant male circumcision an abuse of the rights of the child?"

British National Health Service consultant Geoff Hinchley leads with a strong yes. He maintains that the procedure is male genital mutilation—akin to female genital mutilation and other kinds of infant abuse that are now illegal in countries like Britain and the United States. He asserts that the procedure damages young boys by decreasing penile sensitivity, something that has been disputed in recent medical reports, yet he ignores considerable medical evidence when he states outright that "the procedure will provide no medical benefit." He wants boys protected from the procedure and invokes the U.N. declaration on the rights of children, which directs governments to take legislative, administrative, social, and educational measures to protect children from all forms of violence, injury, or abuse. He's supportive of parents putting off the procedure until the child or young man can make the decision for himself.

There's no doubt that what emerged as a cultural and religious practice dating back thousands of years has been medicalized. Circumcisions have been routinely advised for decades based on the premise that they allowed for better hygiene and on evidence that cervical cancer was less common in women married to circumcised men. Since then medical studies have questioned some assertions in favor of circumcision, such as diminished risk of penile cancer. Other studies, however, have reinforced its considerable benefits, in particular a lower risk of harboring and passing on sexually transmitted disease. Multiple clinical trials from Africa have shown that being circumcised cuts a man's risk of contracting HIV by well over 50 percent. Circumcision does not substitute for condoms, of course. But the findings are strong enough to put the Centers for Disease Control and Prevention and many public health mavens onto the circumcision bandwagon.

Before we overturn that cart, it might be better to focus on the question, "Does male circumcision bring enough medical benefit to justify risk?" Done properly, the medical and personal risks are minimal, if any. As I see it, the benefits are biologically plausible and are supported by the weight of current evidence. That said, the known benefits are not strong enough to rise to the level of mandating the procedure as we do childhood vaccines. Thus, as it always has been, circumcision remains a parent's choice.

I encourage parents to review the existing information. If they decide they want to have their infant son circumcised, they should have it done by a professional who has experience in performing procedure and in providing local anesthesia so that the child experiences no discomfort. I caution parents, however, against delaying the decision until the child is old enough to decide for himself. Get real. Not many teenage boys would relish the discussion, let alone the act. Nor do I think they would have the perspective to weigh the medical pros and cons.

In a time when it is appropriate to question the use or overuse of certain medical procedures, however minor they might seem, having these discussions in medical journals and in public circles is healthy. What is not healthy in this free flow of ideas is to diminish the real abuse of female genital mutilation with a trumped-up portrayal of the "abuse" that infant circumcision allegedly exacts on our helpless baby boys.