Should Infant Male Circumcision be Mandatory?

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The Centers for Disease Control and Prevention is reportedly considering mandatory circumcision for all male infants born in the United States, as some studies show that uncircumcised males have a much higher rate of HIV infection than those who are circumcised. Advocates of mandatory circumcision believe this step will significantly reduce the incidence of HIV and subsequently, AIDS.

Circumcision is a surgical procedure in which the foreskin, a hood of skin that covers the head of the penis, is removed. The procedure is typically performed within the first ten days of birth. Circumcision that is performed later in life is a more complicated event.

Reasons parents choose to circumcise their sons include religious beliefs, concerns about hygiene, and cultural or social reasons. Hispanics, blacks, and foreign-born Americans are less likely to undergo circumcision than white Americans. For both Jews and Muslims, male circumcision is deeply ingrained in religious tradition.

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According to the National Hospital Discharge Survey, which is produced by the National Center for Health Statistics (an agency of the Centers for Disease Control and Prevention), the overall rate of circumcision in the United States in 1994 was 62.7 percent and 56.1 percent in 2006. The western region has consistently shown the lowest rates, while the north central states have the highest.

Concerns about hygiene and disease transmission are the reasons being raised in the current debate; specifically, transmission of HIV, as some observational studies have reported an association between male circumcision and a reduced risk of HIV infection in female sex partners. In a study conducted by Johns Hopkins University in Uganda and recently published in Lancet (July 2009), researchers did not find this to be true, however. Circumcision of HIV-infected men did not reduce HIV transmission to female partners over a two-year period.

Other studies, however, have focused on whether African heterosexual men were less likely to acquire HIV after circumcision, but did not investigate whether they were more likely to transmit the virus to women. Most studies have also concentrated on heterosexual transmission of HIV in African men, but in the United States the higher risk is among men having sex with men.

Currently, the American Academy of Pediatrics and the American Academy of Family Physicians do not endorse circumcision as a way to prevent sexually transmitted diseases, urinary tract infections, penile cancer, or various inflammatory conditions that affect the penis. The procedure is considered to be neither essential nor detrimental of a male’s health. Rather than make male circumcision mandatory, a better route may be to present parents with information about the pros and cons of the procedure, including what researchers know and don’t know about the transmission of HIV related to circumcision, and let parents make up their own minds.

SOURCES:
American Academy of Family Physicians
American Academy of Pediatrics
National Hospital Discharge Survey
New York Times, August 29, 2009
Siegfried N et al. Cochrane Database of Systematic Reviews 2009 Apr 15(2):CD003362
Wawer MJ et al. Lancet 2009 Jul 18; 374(9685): 229-37

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Comments

If circumcision prevents HIV, why does the US have one of the highest rates of circumcision, and one of the highest rates of HIV infection....far higher than any country in Europe, where circumcision is uncommon? Those flawed African studies were poorly designed, and poorly executed. People who are unabashed circumcision advocates, such as Daniel Halperin, were involved, so they can hardly be called impartial. Among African countries which circumcise, the rate of HIV infection is higher among circumcised males than it is among intact males, such as Rwanda, Cameroon, Ghana, Lesotho, Malawi, and Swaziland. What happened to "first, do no harm"? Circumcision removes 50% or more of the skin of the penis, including areas which are more responsive than the glans, such as the inner foreskin and frenulum. If we were talking about removing 50% of the skin of a vulva, people would call us insane, yet it is accepted if it is done to a male baby. This is simple sexism. Who is it actually serving, besides the status quo? Certainly not the screaming child, who gets only a false promise. If we have to wear a condom to be safe, even after a circumcision, why remove the most sensitive part of a male body?
The position that routine infant circumcision will reduce HIV is wrong on so many levels. Wake up America and THINK! First, most sexually active men in the US are already circumcised. Circumcising the last few will not make a dent in the rate of HIV in the US, which is already high. Second, babies do not have sex. So, RIC is not relevant to reducing HIV in the near term. Let the adult man decide if he wishes to have a portion of his sex organ removed by circumcision. If the man is smart, he will wear a condom when having at-risk sex with his foreskin. Third, having non-medically required surgery on an infant is a violation of that infant's human rights and bodily integrity. It is illegal to perform non-medically required genital surgery on infant girls in the US. Why is there a double standard that allows genital surgery on baby boys? Many men are finding out that they miss their foreskin. They, like myself, are restoring their foreskin to regain what was taken from us at birth. See www.RestoringForeskin.org to read accounts of men who wish they had never been circumcised and are doing something about it. Also, many of those men are very upset with their parents for having them circumcised. This is particularly true of the younger men, who can easily research circumcision on the Internet and wonder why their parents ignored the evidence available to them.
OK, you've listed reasons to circumcise. There are also a few reasons not to circumcise. 1. It's his body, not yours, and he may very well grow up to want to make up his own mind about which parts of his own body he wants cut off. 2. The foreskin has erogenous and protective functions. Shakespeare called it "my sweet ounce of man's flesh" and as usual, he knew what he was talking about. Men circumcised in adulthood have described the difference as "like going colorblind". (It's not the quantity of sensation, it's the quality.) 3. Circumcision has definite risks, up to and including death - rare, but just as tragic as any other death. A baby only needs to lose two serving-spoons of blood (30ml) to be in danger, and that much is easily concealed by modern gel-filled diapers. MRSA is another unnecessary risk. It is not "just a snip" but surgery, with all the risks that surgery entails, including taking too much: a baby's penis is tiny and any error will be magnified when he grows up. 4.Many claims for circumcision have been made and later disproved; we should be skeptical of new ones. It does not protect against the commonest STDs at all, and there are better ways to prevent the rare ones. Seven out of ten men in the world (including most of the rest of the developed world) are intact and never have any problems, so hundreds of circumcisions are wasted for every one that does any good. The good news is that the CDC has clarified its stance: circumcision will be "completely voluntary" and that can only mean leaving him alone until he's old enough to make up his own mind.
Male masturbation diminishes female sexual power. Circumcision can curb the bad habit.
The CDC and other medical organizations know a catheter is easier to insert when the male has been circumcised. It doesn't rate high on the long list of compelling reasons to amputate the surplus skin, but shows how long the list is. The male is properly excluded in the decision to remove his foreskin at birth.
Thank you for sharing this important reason to consider circumcision. It is likely one parents don't consider when making their decision, and it should be presented to them when reviewing the benefits and risks.
I agree, another good reason.
I think it's just cruel. The skin is there for a reason. We are created perfectly.
Maybe leaving your son uncircumcised is cruel. It is often rather hard to get circumcised as an adult.
Yes it is. With good teaching of hygiene there shouldn't be a problem. Of course, it should be a choice. Since there is more than one school of thought...shown here, the issue again is should it be mandatory?
So you don't have a problem with parents having their son circumcised?
No! I'm a nurse. I just have a a professional opinion about teaching hygiene that I've shared. Not so long ago they circumcised without giving any type of anesthetic. That's changed thankfully, but the procedure was undeniably cruel.
Yes, it should. Maybe postponed to 12-14 years of age, but parents shouldn't be able to deny their son circumcision.
I can't believe people are promoting this kind of barbarism in the 21st century. Almost all boys who are circumcised will experience chapping, bleeding and scarring on the heads of their penises. People don't seem to care about the quality of life about these boys, and the argument is totally invalid, since children are not even at risk of getting sexually transmitted diseases. There are innumerable forums where guys, like myself, are going to drastic measures to try to stretch the remainder of their skin that was amputated to make some sort of makeshift foreskin. Boys should be left alone until they are old enough to make their own decisions.
I support mandatory for baby boys