Misplaced Pages

Revision as of 05:54, 6 May 2006

Circumcision advocacy refers to those who advocate circumcision and their activities in support of this cause. The term may be used more frequently by those opposed to circumcision but there is a Jewish website called Advocating Circumcision Today. The term circumcision advocacy is used in an article by Hodges, Svoboda and Van Howe in the Journal of Medical Ethics and also by Benatar and Benatar in an article in the American Journal of Bioethics

Circumcision advocates may undertake social and political activity to promote it and ensure access and funding for circumcision. Many advocates of circumcision believe that it is an essential public health measure, and some are active in countries that do not practice elective non-therapeutic circumcision. However, arguments for circumcision are usually more common in those who practise it for cultural or religious reasons. Circumcision advocacy often opposes the views of the Genital Integrity movement, but there are individuals who support voluntary adult circumcision but oppose the circumcision of minors.

History

Historically, circumcision was argued for on religious or traditional grounds. Philo Judaeus in the 1st Century defended Jewish circumcision on several grounds, including health, cleanliness, fertility and as a symbol of "the excision of all superfluous and excessive pleasure" .

However, over the past century, medical advocacy has taken prominence. The prophylactic benefits claimed for non-therapeutic male circumcision continue to be disputed by advocates and opponents (see Medical analysis of circumcision). Some advocates of non-therapeutic circumcision have also stated a preference for the look of a circumcised penis .

Ephron reports that Gentiles and also some Jewish reformers had criticized ritual circumcision as "barbaric" in early 19th Century Germany. He stated that Jewish doctors responded to that criticism with defences of the ritual or proposals for modification or reform. By the late 19th century some German Jewish doctors defended circumcision by claiming it had health advantages.

Prominent circumcision advocates in English-speaking countries

Circumcision spread in several English-speaking nations from the late Nineteenth Century. One reason for this was promotion by doctors such as Sir Jonathan Hutchinson in England . Peter Charles Remondino, of San Diego, wrote a History of Circumcision from the Earliest Times to the Present: Moral and Physical Reasons for Its Performance (1891), to promote circumcision. Lewis Sayre, a prominent American Orthopedic surgeon at the time, was another early American advocate. Abraham Wolbarst, a New York Jewish doctor, published an article 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 to document his claim. Some 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.

Doctors and others also advocated circumcision to prevent masturbation, which was then considered sinful and harmful. Late in the Nineteenth Century, 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) As late as 1936. L. E. Holt, an author of pediatric textbooks, advocated male and female circumcision to prevent masturbation .

Today it is widely accepted that circumcision does not prevent masturbation and that masturbation is harmless. Recent research has suggested that masturbation may even help to avoid prostate cancer . A 1997 study by Laumann et al. found that circumcised American men actually masturbated more frequently.

Dr. Benjamin Spock (d. 1998), who originally supported circumcision, changed his mind near the end of his life (B. Spock, Circumcision - It's Not Necessary Redbook, April 1989). Dr. Thomas Wiswell, who was originally opposed to circumcision, later changed his mind after his research revealed a protective effect against urinary tract infections . Dr. Edgar Schoen, (b. 1925) former chair of the American Academy of Pediatrics' Task Force on Circumcision, maintains a web site promoting circumcision and claims physical benefits in sexual performance in addition to medical arguments. Aaron J. Fink, M.D. (d. 1990), another late 20th century circumcision advocate, self-published Circumcision: A Parent's Decision for Life to promote his ideas.

Prevalence of advocacy efforts

Routine infant circumcision caught on most in the United States, Canada, and Australia, where infant circumcision became routine for males after World War II. However, unlike most of the United States, circumcision rates fell sharply in Canada and Australia during the second half of the Twentieth Century. In 2002, Dr Kendel, the registrar of the College of Physicians and Surgeons of Saskatchewan warned physicians in a memo that consumer pressure could result in future malpractice suits if the utmost care in obtaining informed consent is not taken. . The Medical Journal of Australia has published an article expressing concern that too many boys were being circumcised for phimosis, when simpler remedies than circumcision were available . Male non-therapeutic circumcision has not been regarded as "routine" for many years in any country.

Both Australia and Canada have circumcision advocates. Dr. Pollock, a Canadian doctor who concentrates on vasectomies and circumcisions, asserts that he has safely performed over 16,000 circumcisions claiming a lifetime of medical benefits. In Ontario, Canada, Dr Aaron Jesin, a General Practitioner, runs a circumcision clinic. His website reproduces a Circlist webpage containing articles from before the year 2000 on the medical benefits claimed for circumcision . In Australia, Professor Brian Morris, author of "In Favour of Circumcision" said, "It was never my intention to be the biggest campaigner for circumcision in Australia. Really, I’m a campaigner for science." Morris writes that circumcision confers many medical benefits including reduced risk of UTIs, penile cancer, HIV, balanitis, posthitis, phimosis, and prostate cancer and argues that circumcision has sexual benefits .

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 , not considering the father's status or wishes. This continued until the 1970s, where statistics show high levels of circumcision 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. 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.

Legal and economic aspects

Medicaid funding for infant circumcision used to be universal in the United States. However, 6 states had abolished the subsidy by 2000 and by mid-August 2005, 16 of the 50 states had abolished Medicaid funding for circumcision , something that anti-circumcision campaigners have documented . Some obstetricians have found that infant circumcisions are a quick and easy way of making money . While some doctors and medical lobbyists resisted cuts in the public funding of circumcision, giving a variety of reasons, it was noted that they stood to lose money from the subsidy cut. There is a report of a Hong Kong hospital setting a fixed price for circumcisions as a way of attracting patients during an economic downturn . In 2004, New Mexico legislated mandatory insurance coverage for male circumcision . There are reports of health insurance fraud involving circumcisions by Paul Rubin in the Phoenix New Times, 24 April 2003 and 1 January 2004 and by Christopher Snowbeck in the Pittsburgh Post-Gazette, 26 March 2005 .

A Missouri study found no significant difference between uninsured and privately insured patients in regard to newborn circumcision., This study was done in the years 1997-2001, at a time before the Medicaid subsidy for newborn circumcision had been abolished in Missouri.

Have advocacy efforts affected circumcision practices?

While neonatal in-hospital circumcision rates in the U.S. were 64.3% in 1979 and 65.3% in 1999, 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. 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. However, the increase may also result in a higher incidence of surgical complications of circumcision.

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

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 .

See also

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

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 by Dr David Hawker, General Practitioner, UK
• Medical Benefits of Circumcision by Professor Brian Morris, Australia
• Circumcision: a lifetime of medical benefits by Dr. Edgar J. Schoen, USA

Critics of circumcision advocacy

• Myths about circumcision
• Circumcision Positions of Advocates and Critics
• Circumcision: The Step to Becoming a REAL Man

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)

• Circumcision debate