Male Circumcision A Social And Medical Misconception

Male Circumcision: A Social And Medical Misconception Essay, Research Paper

Male Circumcision: A Social and Medical Misconception

University of Johns Hopkins

Introduction

Male circumcision is defined as a surgical procedure in which the prepuce

of the penis is separated from the glands and excised. (Mosby, 1986) Dating as

far back as 2800 BC, circumcision has been performed as a part of religious

ceremony, as a puberty or premarital rite, as a disciplinary measure, as a

reprieve against the toxic effects of vaginal blood, and as a mark of slavery.

(Milos & Macris, 1992) In the United States, advocacy of circumcision was

perpetuated amid the Victorian belief that circumcision served as a remedy

against the ills of masturbation and systemic disease. (Lund, 1990) The

scientific community further reinforced these beliefs by reporting the incidence

of hygiene-related urogenital disorders to be higher in uncircumcised men.

Circumcision is now a societal norm in the United States. Routine

circumcision is the most widely practiced pediatric surgery and an estimated one

to one-and-a-half million newborns, or 80 to 90 percent of the population, are

circumcised. (Lund, 1990) Despite these statistics, circumcision still remains a

topic of great debate. The medical community is examining the need for a

surgical procedure that is historically based on religious and cultural doctrine

and not of medical necessity. Possible complications of circumcision include

hemorrhage, infection, surgical trauma, and pain. (Gelbaum, 1992) Unless

absolute medical indications exist, why should male infants be exposed to these

risks. In essence, our society has perpetuated an unnecessary surgical procedure

that permanently alters a normal, healthy body part.

This paper examines the literature surrounding the debate over circumcision,

delineates the flaws that exist in the research, and discusses the nurse’s role

in the circumcision debate.

Review of Literature

Many studies performed worldwide suggest a relationship between lack of

circumcision and urinary tract infection (UTI). In 1982, Ginsberg and McCracken

described a case series of infants five days to eight months of age hospitalized

with UTI. (Thompson, 1990) Of the total infant population hospitalized with UTI,

sixty-two were males and only three were circumcised. (Thompson, 1990) Based on

this information, the researchers speculated that, “the uncircumcised male has

an increased susceptibility to UTI.” Subsequently, Wiswell and associates from

Brooke Army Hospital released a series of papers based upon a retrospective

cohort study design of children hospitalized with UTI in the first year of life.

The authors conclusions suggest a 10 to 20-fold increase in risk for UTI in the

uncircumcised male in the first year of life. (Thompson, 1990) However, Thompson

(1990) reports that in these studies analysis of the data was very crude and

there were no controls for the variables of age, race, education level, or

income. The statistical findings from further studies are equally misconstruing.

In 1986, Wiswell and Roscelli reported an increase in the number of UTIs as the

circumcision rate declined. By clearly leaving out “aberrant data”, the results

of the study are again very misleading. In 1989, Herzog from Boston Children’s

Hospital reported on a retrospective case-control study on the relationship

between the incidence of UTI and circumcision in the male infant under one year

of age. Here too, the results were not adjusted to account for the variables of

age, ethnicity, and drop-out rate of the participants. It is obvious that this

research is statistically weak and should not be the criteria on which to decide

for or against neonatal circumcision.

Lund (1990) reports that a study conducted by Parker and associates

estimates the relative risk of uncircumcised males to be double that of

circumcised males for acquiring herpes genitalis, candidiasis, gonorrhea, and

syphilis. Simonsen and coworkers performed a case-control study on 340 men in

Kenya, Africa in an attempt to explain the different pattern for acquired immune

deficiency syndrome (AIDS) virus in Africa as compared to the United States.

(Thompson, 1990) The authors conclude that the relative risk for AIDS was higher

for uncircumcised men. Results from similar studies in the United States remain

conflicting. Although most of the existing studies do associate a relationship

between the incidence of venereal disease and circumcision, the American Academy

of Pediatrics found existing reports inconclusive and conflicting in results.

(Lund, 1990) There is an overwhelming incidence of STD and AIDS in the United

States, where a majority of the men are circumcised.

It is imperative that we look at ways of altering our risk of exposure to

these agents than at altering the sex

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