I don't generally watch the Dr. Oz Show. I used to like him very much, when he was on Oprah, but the new show is a little much for me. I think it's a great thing he does, educating people about their bodies and how they can be healthier. I think an informed patient is a safer, healthier patient.
I tuned in today to the Dr. Oz Show to see what he was going to say about the proposed San Fransisco Circumcision ban. The measure, which requires 7,000 signatures to make it on to the ballot next November, would make it a misdemeanor to "circumcise, excise, cut, or mutilate" the genitals of all minors, and does not make exceptions for religious reasons.
On the show today, circumcision was brought up in the context of this bill during a segment (that I gather is a recurring one) called "The Pulse," which addresses the "hottest health news" with a panel of experts to weigh in with their opinions along with Dr. Oz. He introduced the three other doctors: a Psychiatrist, an OB/GYN, and a Pediatrician. Then, he started by saying, "Here's the deal: circumcision reduces the liklihood of receiving and transmitting sexually transmitted illnesses during unprotected sex." He proceeded to bring a woman wearing a turtleneck onto the stage, had her pull the neck up over her head, effectively turning her into an intact penis. He then dumped a jar of large paper confetti on her to illustrate "bacteria, viruses, other issues that might get into a penis," showing that some of it gets trapped under the pretend foreskin. After that, Dr. Oz pulled a thread out of the turtleneck which removed the top portion of the neck of the shirt, effectively "circumcising" her and exposing all of the "issues" that the prepuce trapped inside. Voilà! All is well in the world when we circumcise.
The experts weighed in on what they thought about the issue (I will summarize). The Pediatrician said it's a personal choice people have to make for their own family, but that we don't want to propagate disease, that's the most important thing, and finally that kids want to look like their dads. The Psychiatrist said that parents need to make those choices, but we don't want to give a false sense of security about circumcised penises. The OB/GYN said that with respect to how it affects women, it's an issue for them because they'll have to make these decisions for their children, it's a sexual health issue because of exposure to disease, and it's a cosmetic issue. The segment ended as they all seemed to agree that the decision was a personal one and should not be interfered with by the government.
They brought up a few main points: circumcising to prevent spread of disease, circumcising so the child will "look like Dad," and circumcising for cosmetic purposes.
First, and this was the one that was emphasized over and over on the Dr. Oz show today: prevention of infection by and transmission of sexually transmitted infections. From Birth Sense: "The World Health Organization, the Joint United Nations Programme on HIV/AIDS, and the Centers for Disease Control and Prevention state that circumcision provides minimal protection and
does not eliminate the need to use a condom to prevent transmission of HIV." Some studies have shown a decrease in STDs and HIV in uncircumcised men, but not all studies have supported that circumcision decreases STD transmission.
One of the problems with these studies (particularly the ones focused on infection with HIV) is that they've been done on populations that aren't directly comparable to the general American public. For instance, one widely-publicized study on HIV transmission was done on African men in developing countries. The study looked at men who were circumcised as adults as a measure to protect against HIV infection and transmission, and it found there was a decrease in infection, but with a 40% failure rate. Even if the studies were statistically sound, which they were not, the failure rate is much too high to support the use of circumcision to prevent STDs. For comparison, the failure rate of a male condom is 3-14%, and in those instances, infection is merely possible, not guaranteed.
Other studies, however, have shown the exact opposite: that HIV infection in adult African men was greater in those who were circumcised (purportedly because of a decrease in condom usage among this population, since they thought they were "protected" by being circumcised). It's not scientifically sound to compare two populations that are not alike (adult men from developing countries and infant males in developed countries). Even if circumcision of adult men in developing countries prevents the spread of STDs, that's not sufficient evidence for routine circumcision of infant males in developed countries.
Let's assume for a moment, that circumcision does, in fact, prevent the spread of HIV and other sexually transmitted infections. Then, logically we could conclude that populations with the highest percentage of circumcised men would have the lowest incidence of STDs, right? Wrong. As Peaceful parenting points out, the United States has the highest circumcision rate and also the highest incidence of STDs (including HIV) of any Western nation. "Developed nations where 98-99% of their boys/men remain intact have the
lowest rates of STDs (including HIV). If circumcision "protected" against diseases,... we would not see these figures to such an
extreme and obvious degree."
Frankly, I think the key here is that we're talking about unprotected sex...which no one should be having unless: 1. They're in a committed relationship with 2. someone they trust and are 3. alright with getting pregnant. Everyone else should be using condoms when they have sex. Every single time.
Condoms prevent the spread of HIV and other STDs, as well as being faithful to one partner or abstaining from sex. Circumcision does not.
Looking Like Dad
I have to say, this is one reason I've never understood for circumcising babies. Infant and little boy penises don't look like adult man penises, no matter if they have a foreskin or not, because they're not sexually mature. So why would we perform non-medically-indicated surgery on babies to make them "look like Dad"? By the time their genitals have the potential to look like their fathers', they're probably not going to be seeing each other naked.
I imagine that the moment when an intact child realizes he looks "different" from his dad isn't that big of a deal. The son asks "Why?" and the father says, "Because I'm circumcised and you're not. We kept you whole." Then, the moment is over. What's the big deal about having "matching" genitals? We don't surgically alter baby girls' labia to match their Moms'!
Furthermore, we all look different from each other in lots of ways. In my mind, there's no reason to subject newborns to unnecessary surgery in order to ensure that they look more like their fathers...but just in the pants.
Routine infant circumcision is pretty much a uniquely American thing. In the United States last year, the circumcision rate dropped to 33%, down from 56% in 2006. If you're worried your kid is going to be made fun of in gym class (I was never naked in gym class, and I'm sure they're even more strict about it nowadays) know that he'll be in the minority if you get him circumcised. He'll be even more in the minority if you ever travel out of this country, even to Canada. There are millions of sexual partners of uncut men worldwide who can attest to the fact that there's absolutely nothing off-putting or sexually unattractive about a penis that hasn't been through cosmetic surgery.
You can be arrested for tattooing your children. Experts question whether teens are too young to undergo cosmetic surgery for a crooked nose or ears that stick out. So why are our newborn infants old enough to have perfectly functioning body parts amputated for cosmetic reasons? And more importantly, how can they give consent?
Obviously, they can't. We wouldn't give a brand new baby a rhinoplasty ("nose job") simply
because we thought maybe some day someone might make fun of her, or a
future romantic partner wouldn't find her as desirable. If the reason we're circumcising our babies is because it's prettier that way, why not let our sons decide what they think of their own penises when they are old enough to elect to have the surgery and then consent to it without a parent's signature.
I am obviously anti-circumcision for many reasons, not just those I've outlined here. My husband and I chose to leave our son whole.
I think The Dr. Oz Show did a poor job of providing the American people with accurate facts on routine infant circumcision. I believe that, since Dr. Oz is an influential person and a medical professional, he has an obligation to provide people with the most accurate and balanced information available, regardless of his personal opinion on the subject. This is especially true when he's advocating for a medical procedure that is not recommended by the Centers for Disease Control or the American Academy of Pediatrics. In fact, no medical organization in the world recommends routine infant circumcision.
We now know that babies do feel pain
that is unrelieved by simply giving them sugar water. (Surprising, I know, but now we have research to prove it!) Anesthetic is not
required to be used for infant circumcision surgery, and that's wrong. A 2006 study revealed that of programs that taught administration of topical or local anesthetic for circumcision surgery, only 84% used anesthetic "frequently or always" when the procedure was conducted.
We can do better by our sons, and I think we're beginning to. Americans are obviously starting to come around to realize how unnecessary this procedure really is, as evidenced by the sharp decrease in circumcision rates over the past few years. Many Jewish families are opting for a Brit Shalom (Covenant of Peace) in lieu of the traditional Brit Milah (Covenant of Circumcision), since they feel circumcision is unnecessary. Here, read a Jewish father's letter to his son about their Covenant of Peace.
What I've written here is in no way meant to blame or look down upon those who have chosen to circumcise their sons. I know several families who have multiple sons, the older of whom are circumcised, and the youngest of whom were left intact. This perfectly illustrates where I think (and hope) we're moving with circumcision: we thought it was alright, but now we know it's not.
Maya Angelou once said, "Do the best you can until you know better. Then when you know better, you do better." I know we're all doing the best we can. But now we know better. Let's do better.
For more information on circumcision in general, check out Code Name: Mama's series on researching circumcision: Part One, about the functions of the foreskin, Part Two about the circumcision procedure itself, and Part Three, about common concerns/myths about circumcision. For more resources about Judiaism and circumcision, visit Peaceful Parenting.