Circumcision advocacy

Circumcision advocacy is the social and political movement to promote infant circumcision and ensure access and funding for the procedure, usually performed on a male child. Advocates of circumcision are sometimes termed "circumcisionists". Advocates believe circumcision is an essential public health measure, and some are active in countries that do not practice routine circumcision. However this usually runs along cultural lines, with strong debate on both sides. Advocacy of circumcision is sometimes considered the opposite of the genital integrity perspective.

History

Philo Judaeus in the 1st century considered circumcision necessary to our well being. Historically, circumcision has been argued for on religious or traditional grounds. However, over the past century, advocacy based on medicine has taken prominence. The benefits themselves continue to be disputed by opponents (see Medical analysis of circumcision).

Ephron reports that the practice of advocating circumcision started in 19th century Germany. Gentiles criticized the Jewish practice of ritual circumcision as "barbaric" and Jewish doctors responded to that criticism with medical arguments to defend the practice of ritual circumcision.[1] Ephron reports that Jewish doctors in 19th century also tried to use medical argument to extend the practice of circumcision to Gentiles, apparently without much success.[2]

Famous circumcision advocates in history

The practice of promoting circumcision based on medicine spread to several English-speaking nations from the late Nineteenth Century. Lewis Sayre, a prominent American Jewish doctor of this period, was an early American circumcision advocate. Abraham Wolbarst, a New York Jewish doctor, advocated circumcision in the early 20th Century.[3] He wrote an article published in the Journal of the American Medical Association in 1914 advocating universal circumcision for health reasons. He started to advocate circumcision to prevent penile cancer in 1928, and in 1932 he published a study in order to prove his claim. More recent studies have shown that circumcised men are at a reduced risk, particularly from invasive penile cancer, though circumcision does not provide complete protection. For further discussion, please see: medical analysis of circumcision.

In the late 19th and early 20th century, a number of doctors advocated circumcision to prevent masturbation, which was then considered sinful and harmful. L. E. Holt, an author of pediatric textbooks, advocated male and female circumcision to prevent masturbation as late as 1936.[4] Earlier, Dr. John Harvey Kellogg recommended circumcision of boys, writing: "A remedy for masturbation which is almost always successful in small boys is circumcision.... The operation should be performed by a surgeon without administering anaesthetic, as the pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment." (Kellogg, 1888)

Peter Charles Remondino, of San Diego, wrote a book published in 1891, History of Circumcision from the Earliest Times to the Present: Moral and Physical Reasons for Its Performance, to promote circumcision.[5]

Despite the intent, circumcision does not prevent masturbation. A 1997 study by Laumann et al. found that circumcised men actually masturbate more frequently.[6] Nowadays, it is believed that masturbation is not harmful, and according to recent research may even help to avoid diseases of the prostate.

In the 1950s and 60s, there are indications that orphans and mentally handicapped boys have been treated by the procedure.[7] Routine infant circumcision caught on most in the United States, Canada, and Australia, where infant circumcision became routine for males after World War II.

Aaron J. Fink, M.D. was a late 20th century circumcision advocate. He authored a self-published book, Circumcision: A Parent's Decision for Life to promote his ideas.

Prevalence of advocacy efforts

In areas where circumcision is the norm people often fear that a boy will be traumatized without circumcision, particularly if teased in school or he realizes his genitals are different from his circumcised father or peers. Medical professionals are also more likely to maintain a pro-circumcision viewpoint in areas where circumcision is or was the norm.

In the book In Favour Of Circumcision, Australian professor Brian Morris details his pro-circumcision arguments [8]. Morris says "It was never my intention to be the biggest campaigner for circumcision in Australia. Really, I’m a campaigner for science." [9] Morris promotes circumcision for a number of reasons. He writes that circumcision confers many medical benefits including reduced risk of UTIs, penile cancer, HIV, balanitis, posthitis, phimosis, and prostate cancer. He also argues that circumcision has sexual and cultural benefits.

Dr. Benjamin Spock who originally supported circumcision, changed his mind near the end of his life. Dr. Thomas Wiswell, who was originally opposed to circumcision while in medical training, later changed his mind after his research revealed a protective effect against urinary tract infections. Dr. Edgar Schoen, former chair of the American Academy of Pediatrics' Task Force on Circumcision, maintains a web site promoting circumcision [10] and claims physical benefits in sexual performance in addition to medical arguments.

Circumcision has sharply declined in Canada.[11] [12] However, there are Canadian advocates for the practice. In Vancouver, a Dr. Pollock has safely performed over 10,000 circumcisions [13] and claims a lifetime of medical benefits. In Ontario Dr Aaron Jesin, a General Practitioner, runs a circumcision clinic.

Advocacy in U.S. Hospitals

In the early 20th century, when a majority of adult men were uncircumcised, some US doctors strongly advocated circumcision. According to one article from 1941, parental consent had started to be viewed as optional [14], not considering the father's status or wishes. This continued until the 1970s[15], where statistics show high levels of circumcision[16] during the time period when hospital intervention was at its highest. At that time, male circumcision was effectively automatic at many hospitals until lawsuits changed the direction of advocacy efforts to include parents[17]. By the 1980s, consent forms were widely available, and most parents had the option not to circumcise sons. However, a majority of American men were circumcised by that point in time. Some hospitals are still active in promoting circumcision without consulting with parents, although a consent form must be provided.[18]

Legal and economic aspects

Medicaid funding for circumcision used to be universal in the United States. However, 13 of the 50 states have abolished Medicaid funding for circumcision [19]. New Mexico has recently legislated mandatory insurance coverage for male circumcision. [20]

Although some insurance companies have declined coverage of circumcision, one study has shown that insurance coverage does not significantly affect rates among newborns. [21]

Have advocacy efforts affected circumcision practices?

While circumcision rates in the U.S. were 64.3% in 1979 and 65.3% in 1999,[22] significant changes took place. Circumcision rates amongst Blacks rose to equal the rates amongst Whites and the circumcision rate in the Western states declined sharply. The National Center for Health Statistics attributes this partly to an increased birth rate amongst Hispanics in this region. [23] A recent study, however, using the Nationwide Inpatient Sample, concluded that: "There was a significant increase in the rate of newborn circumcision between 1988 and 2000. The increase may be related to increased recognition of the potential medical benefits of circumcision."[24]

In the United Kingdom circumcision rates have steadily declined since the 1930's, and non-therapeutic circumcision is now rare [25]. Circumcision is declining in Canada [26] and has declined from 95% in the 1940s to less than 1% (as of 1995) in New Zealand [27]. The circumcision rate in Australia rose slightly from 10.7% in 1996 to 12.7% in 2004 [28].

It would be hard to determine how much of these changes were due to advocacy for or against circumcision or to other social changes. in North Carolina in 2002, anti-circumcision advocates urged the abolition of the Medicaid subsidy for circumcisions while some obstetricians and gynecologists lobbied hard for the retention of the subsidy. Nevertheless, the effect of immigration of people from non-circumcising cultures was also noted [29] .

See also

• Foreskin
• Penis
• Male circumcision
• Medical analysis of circumcision

External links

• John M. Ephron. Medicine and the German Jews. New Haven: Yale University Press, 2001: 222–233. (ISBN 0–300–08377–7) (Excerpt) URL: http://www.cirp.org/library/history/ephron1/

• Gollaher DL. From ritual to science: the medical transformation of circumcision in america. Journal of Social History 1994;28(1):5–36. URL: http://www.cirp.org/library/history/gollaher/

• Ritual Circumcisionist's Kit, 1950s URL: http://americanhistory.si.edu/toolbox/ritual.html

• Dunsmuir WD, Gordon EM. The history of circumcision. BJU Int 1999;83 Suppl. 1:1–12. URL: http://www.cirp.org/library/history/dunsmuir1/

Circumcision advocates

• The Benefits of Male Circumcision
• Call to Circumcise All Baby Boys
• Medical Benefits of Circumcision by Professor Brian Morris
• Circumcision: a lifetime of medical benefits
• Circumcision: The Step to Becoming a REAL Man

Critics of circumcision advocacy

• Myths about circumcision
• Circumcision Positions of Advocates and Critics

References

• Edward Wallerstein. Circumcision: An American Health Fallacy. New York: Springer Publishing Co. 1980.

• John Harvey Kellogg, M.D., Plain Facts for Young and Old. Burlington, Iowa: F. Segner & Co., 1888.

• Peter Charles Remondino. History of Circumcision from the Earliest Times to the Present: Moral and Physical Reasons for Its Performance. Philadelphia and London, 1891.

• John M. Ephron. Medicine and the German Jews. New Haven: Yale University Press, 2001: 222–233. (ISBN 0–300–08377–7)

• David A. Gollaher, Circumcision: A History of the World's Most Controversial Surgery. New York: Basic Books, 2000. 253 pages. (ISBN 0–465–04397–6)