The American Interest
Analysis by Walter Russell Mead & Staff
American Academy of Pediatrics Endorses Circumcision

Loyal VM readers know we’ve been following the debate over circumcision occasioned by the barbarous bans put in place in Cologne and in Vorarlberg Province. VM alum Yair Rosenberg, writing for Tablet, has seen a leaked copy of the American Academy of Pediatrics policy statement on circumcision and notes that it changes the organization’s previous recommendation from “neutral” to “pro”. Why does this matter? Rosenberg:

The importance of this cannot be overstated. The AAP is a driving force behind health policy in America, and the experts involved in its new statement are already going on record in major media outlets to advocate that circumcision be covered on public health plans like Medicaid. The statement solidifies the scientific consensus behind the advisability of infant male circumcision (noting that complications are more likely to arise when the procedure is performed later in life) and places the traditional practice squarely within the realm of sound medical science.

While the kinds of rulings and laws being promulgated in Germany and Austria stood little chance of ever making it to the U.S., this kind of statement makes it even less likely and is thus welcome.

Hopefully anti-circumcision zealots will take a deep breath and rethink their fevered stance on the issue. Beyond the fact that their bans impinge on the rights of Jews and Muslims to practice their religion as they see fit, they ought to consider that there is legitimate science pointing to the practice being beneficial to infant male health.

Published on August 24, 2012 7:00 pm
  • Mark Lyndon

    What other national medical organizations says:

    Canadian Paediatric Society
    http://www.cps.ca/english/statements/fn/fn96-01.htm
    “Recommendation: Circumcision of newborns should not be routinely performed.”

    http://www.caringforkids.cps.ca/pregnancy&babies/circumcision.htm
    “Circumcision is a ‘non-therapeutic’ procedure, which means it is not medically necessary.”
    “After reviewing the scientific evidence for and against circumcision, the CPS does not recommend routine circumcision for newborn boys. Many paediatricians no longer perform circumcisions.”

    Royal Australasian College of Physicians
    http://www.racp.edu.au/index.cfm?objectid=65118B16-F145-8B74-236C86100E4E3E8E
    “In the absence of evidence of risk of substantial harm, informed parental choice should be respected. Informed parental consent should include the possibility that the ethical principle of autonomy may be better fulfilled by deferring the circumcision to adolescence with the young man consenting on his own behalf.”
    (almost all the men responsible for this statement will be circumcised themselves, as the male circumcision rate in Australia in 1950 was about 90%. “Routine” circumcision is now *banned* in public hospitals in Australia.)

    British Medical Association
    http://bma.org.uk/-/media/Files/PDFs/Practical%20advice%20at%20work/Ethics/Circumcision.pdf
    “to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate.”

    The Royal Dutch Medical Association
    http://knmg.artsennet.nl/Diensten/knmgpublicaties/KNMGpublicatie/Nontherapeutic-circumcision-of-male-minors-2010.htm
    “The official viewpoint of KNMG and other related medical/scientific organisations is that non-therapeutic circumcision of male minors is a violation of children’s rights to autonomy and physical integrity. Contrary to popular belief, circumcision can cause complications – bleeding, infection, urethral stricture and panic attacks are particularly common. KNMG is therefore urging a strong policy of deterrence. KNMG is calling upon doctors to actively and insistently inform parents who are considering the procedure of the absence of medical benefits and the danger of complications.”

  • dr kill

    As a medical doctor, circumcised father of three intact twenty-something sons and a thorough reader of the complete alleged AAP statement, I believe you should also have added the two weasel sentences in AAP statement that reveal this statement to be a sop to the religious lobby. You know which ones they are.
    I care not if you mutilate your children; have at it. As with contraceptive services, I resent paying for it.
    And I’m pretty sure they don’t mention benefits to INFANT male health. Just sayin’.

  • dr kill

    I might add that I am in favor of adding HPV vaccine to the list of routine childhood jabs. Boys and Girls. So is the AAP (without any qualifiers of the above sort).

  • thibaud

    Via Meadia, once again slicing fearlessly at the big issues of our day.

  • Charles R. Williams

    Medically speaking male circumcision is a trivial matter. The government should not pay for it and it should be left entirely to the discretion of the parents.

    It is strange that a vocal and passionate group of people wants to make this a public issue.

    Circumcision confers a small benefit to a minority of men and has catastrophic consequences in a microscopic percentage of cases. It seems to offer some protection from STDs to both men and women in a culture with a high rate of promiscuity. None of these medical factors rises to a level that would justify a government policy response.

  • Dan

    The forced cutting of a boy’s penis is a violation of his human rights, just as the cutting of analogous genital tissue is for a girl.

    I dont’ expect the AAP to operate ethically, after all they have a conflict of interest in this $1.9 billion industry.

    What I do expect is that they not encourage their members to solicit an unnecessary surgery–that’s illegal.

    If circumcision is so great, the boy will ask for it when he’s older.

  • Maxwell Jump

    I see far more issues in society caused by the cutting of the umbilical cord than I’ve seen by the cutting of a tiny piece of skin on male newborns.

    The trauma of cutting the umbilical cord has led to the continued infantization of the Western Male. In many instances he makes his own pseudo-umbilical cord and will never leave mommy’s house.

  • Stubbs

    “they ought to consider that there is legitimate science pointing to the practice being beneficial to infant male health” So is circumcision a certain benefit or is its benefit as debatable as this phrasing suggests?

    “…noting that complications are more likely to arise when the procedure is performed later in life” Why risk “complications” anytime? Euphemistic speech tells you all you need to know about the speaker’s honesty. “Complications,” isn’t that so nice!

    Finally, when did we come to accept the notion that religious belief is a sufficient rationale for violence against another human being?

  • Gord

    There is no “analogous genital tissue” on a girl, Dan. That is a meme of the foreskin fetishists, of which you appear to be one, and it minimizes the horror of the barbaric practice of cliterodectomy. One has to be a very sorry soul with not much going on in his life to give this issue any thought whatsoever. Circumcision should be a personal choice of the parents. The government should butt out. Private health plans should cover it because it has demonstrable health benefits. [unnecessary denigration of those with opposed view deleted. ed]

  • adult circumcisee

    i was circumcised as an adult, as part of embracing my ancestral religion. having been sexually active before and after, I can tell you there is NO “loss of function” — quite the reverse, in fact.

    but boy, being circumcised as an adult is no fun :( I sure wish my parents, bless their hearts, had entered me in the Covenant of Abraham at 8 days, before nerve endings develop “down there”…

  • TomB

    As a medical doctor, circumcised father of three intact twenty-something sons and a thorough reader of the complete alleged AAP statement,

    If you were “mutilated” doc, how did you mange to have three kids?

    I’m just happy the anti-circumcision advocates are so annoyingly shrill, it makes it almost impossible to believe them.

  • voorst van der braaten

    Now comes the AAP, paving the way for the next Great War with Germany!

  • Luke Lea

    Like every American in my generation, I was circumcised at birth as a matter of course. * It was justified on the same grounds of hygiene as are being recommended today by the American Academy of Pediatrics. Whether there are good grounds for over-ruling Darwin in this instance (ie, natural selection didn’t know what it was doing) I don’t pretend to know. Whether circumcision interferes with male sexual pleasure is unknowable in principle. We should keep in mind however that most research reports are wrong and never more often as in faddish areas of health and diet. Also, pediatricians have a financial interest in keeping the circumcision ball rolling. Believe it or not their judgment can be swayed by their pocketbooks.

    *In 1962, while hitchhiking through the Middle East, my friend and I were stuck on the Syria-Iraq border waiting for a visa to enter into Iraq. The border official was suspicious that we might be Jews and asked us to drop our pants to prove that we were not. I just laughed and explained that every male in America was circumcised. He didn’t seem convinced and made us wait for hours, probably waiting for a bribe though I was too naive to know. Out of boredom I took out a pocket knife and carved “Nasser is a Jew” in the top of the conference table in the rooms we were waiting in. I can only imagine what happened later when they discovered it but by that time we were long gone. That was my first taste of the Arab-Israeli conflict. I knew zero about it.

  • Kelly

    Apparently, the AMA hasn’t yet compromised the AAP…

  • mishu

    Leaving foreskins intact wastes $2 billion in the U.S. on treating preventible diseases. If you’re for poking holes in kids and changing their chemical makeup to prevent diseases, you should be for snipping a bit of skin off for doing the same.

  • Jim.

    @Dan-

    When a boy is older, he’ll ask why his parents didn’t take care of it when he was a baby.

    Butt out.

  • Bill H

    Notice that most of these comments come from pediatric and internal medicine societies, not from urologists.

    Circumcision lowers the risk of sexually transmitted diseases, virtually eliminates the risk of phimosis, and also significantly lowers the risk of penile cancer (almost non-existent in circumcised males). It is a procedure that has been performed for thousands of years, with minimal morbidity. Compared to the trauma of normal vaginal birth, the trauma of circumcision is relatively minor and of short duration – and I haven’t seen a big push for routine C-sections to avoid birth trauma.

    Dan – the answer is that it is a much simpler procedure for a newborn boy than for a teenager or adult; the risk of complications is much higher in older males.

    No one is pushing for forced circumcision, just for allowing the parents to make the choice. My bet is that a large proportion of the people who are advocating the ban on circumcision are the ones who would have advocated for that mother’s right to abort the fetus just a few weeks earlier.

  • Will

    Yes, a few billion years of evolution MUST be wrong. The AAP said so, after all.

  • Will

    “…their bans impinge on the rights of Jews and Muslims to practice their religion as they see fit…”

    Some countries are even so backwards as to ban Muslim clitorectomies. Wish those crazy anti-clitorectomy “zealots” will finally take a deep breath.

  • Reagan Fan

    I am not a doctor and I have a very, very limited pool of personal knowledge. That being said…

    1. Of the (again, admittedly few) adult males that I have known who have gotten circumcised, to a man they all hate their mothers with a particularly deep seated hatred. This is true even for the man who said he wasn’t cut as an infant due to illness.

    2. Are you uncut and have a woman who is prone to yeast infections? Get ready to spend lots of time cleaning yourself. The gentleman who admitted this said that there was absolutely zero spontaneity in their love life as he had to spend upwards of 30 minutes “preparing” himself.

    I am not saying that this is reason to do it. These are personal experiences from adult males who had to be cut when they were older. I never hear any cons coming from the anti-snip crowd and it sounds to me as if there might be.

    To the gentleman who compared circumcision to FGM. I know there are different levels of FGM depending on where you are in the world. However, if Ayaan Hirsi Ali’s description is to be believed, your false comparison is false. The medical procedure is akin to comparing a toenail removal to a leg amputation.

  • Ryan

    Funny how the people whining and moaning about Germany’s law and “governmental interference with religion” are generally the same lot who went into hysterics over Catholic institutions and hospitals and their stand against governmental decrees forcing them to offer contraceptive devices.

  • Anonymous

    Will,
    Your comment is silly. The difference between male and female circumcision is enormous. As a woman, I will never have relations with an uncircumcized male again due to the infection I received.

  • Jennifer Trias

    “Beyond the fact that their bans impinge on the rights of Jews and Muslims to practice their religion as they see fit, they ought to consider that there is legitimate science pointing to the practice being beneficial to infant male health.”

    Wait, don’t infants have freedom of religion as well? They may not choose to be Jewish or Muslim when they are grown and yet their parents will have made this choice for them. If infants do not have freedom of religion at birth, then when do we acquire it?

    The fact is that it is elective surgery. Even if there are medical benefits they are mostly things that benefit an adult, therefore the surgery can be done at that point.

  • skeptic

    I am a medical doctor and am ambivalent towards circumcision. If parents feel strongly about it I am not going to get in their way. However, this would not be what I recommend.

    Please keep in mind that double mastectomies at birth would prevent breast cancer in women. Forcible removal of tissue at birth is not demonstrably beneficial. The possible loss of benefits of this tissue cannot be measured easily by any current standards.

    Any circumcision advocates should defend their stance on the mastectomy standard: how can you defend one and not the other?

  • RomeoJuliet

    No one is getting circumcised for alleged health benefits, which are minimal in any society where people take daily showers and actually wash their genitals and butts.

    This is just another way for the monotheistic religions to mark their territory. If you ask me the sand gods are all nuts when it comes to sex.

  • CowBarnCentral

    “their bans impinge on the rights of Jews and Muslims to practice their religion as they see fit.”

    Society has always had a vested interest in protecting people (including infants) who can’t protect themselves. Just because the big three sand gods had a vested interest in marking their people a millennium or two ago doesn’t mean we have to let their followers keep marking babies today.

  • Half Canadian

    Evolution doesn’t care what happens after you’ve propagated. If circumcision lowers my chances of getting penile cancer in my 70s (an age which is unnatural w/o technology), I’m all for it.
    Same with STDs. The very fact that you have sex indicates propagation.

  • http://epsilon-power.blogspot.com Alpheus

    “Yes, a few billion years of evolution MUST be wrong. The AAP said so, after all.”

    This is the stupidest argument against circumcision I have *ever* heard–unless you are prepared to claim that Evolution is guided by Intelligent Design.

    Evolution is not an intelligence that works soley by design! It works by chance, and everything else flows from that. In order to have evolution to occur, we need two things: we need a genetic change, and we need it to increase the rate of survival. If we don’t have the first, then it doesn’t matter if it would be beneficial! And if we *do* have the first, but the increase is minimal, then it will likely take a very long time for the change to occur.

    Or are you going to tell me that we shouldn’t be pulling wisdom teeth, or cutting out appendices, or removing extra thumbs (like my daughter’s, when she was 18 months old), or wearing glasses, because Evolution gave them to us, and billions of years of Evolution can’t be wrong?

  • chuck

    From Bill H. at number 17.
    “No one is pushing for forced circumcision, just for allowing the parents to make the choice. My bet is that a large proportion of the people who are advocating the ban on circumcision are the ones who would have advocated for that mother’s right to abort the fetus just a few weeks earlier.”
    You beat me to the punch. From the arrogance emanating from the anti-circumcision comments above,that’s exactly the thought that I had.

  • Craig

    It is up to parents to decide whether to have their boys circumcised. While the anti-circumcision groups have the right to express their opinion too, parents will need to examine the new AAP statement to determine whether the medical benefits to circumcision are worth it.

  • Jim.

    Is it wrong for parents to get their young girls’ ears pierced?

    It isn’t that tough to compare the experience of a circumcised adult male vs. an uncircumcised adult male. Ask one who was circumcised as an adult.

    Wait, one of those was kind enough to post here already, and they said that there was no downside.

    Interesting question: Does a woman have a right to have their fetus (male or female) circumcised in utero?

  • Will

    To those people who believed I was comparing circumcision to clitorectomy: I was not.

    I was pointing out the problem inherent in letting all people practice their religion freely. The state routinely puts restrictions on religion, and it is appropriate. I have no problem with circumcision–I have a problem with faulty arguments.

  • dr kill

    I am just remembering the best part of our ( me and the bride) personal anti-circumcision decision for our oldest son.
    There we were, in the maternity ward (for paying clients ) of the Hospital of the University of Pennsylvania. August 16, 1984. While discussing the pros and cons of circumcision with our MD, what do you suppose was the leading reason for circumcision at HUP in 1984? Cancer? HIV? HPV? Vaginal yeast infections? Sadly no.

    MD- Don’t you want your son’s penis to look like yours?

    I rest my case. Mutilate away, my religious friends. If this statement allows you to sleep at night I’m all for it. Pleasant dreams.

  • Will

    Alpheus,

    There are certainly mistakes in genes from time to time. But it seems that we’re born with at least 99% of the right parts. We don’t cut off ears or toes. In the west we don’t stretch our necks or pierce our lower lip to install a wooden dish. I’m thinking that in 99% of cases, it is probably not wise to fool with the design that resulted from billions of years of evolution.

    Science is sometimes arrogant. Doctors used to consider tonsils to be worthless and removed them at the first sign of trouble. But we later discovered that they play a role in the immune system. I’m guessing that the foreskin serves a purpose as well, although I will concede that humans’ adoption of clothing might have made it less important.

    Circumcision just strikes me as a religious practice. I have nothing against it, per se. It seems harmless, but I find any scientific justification for it to be dubious. A visitor from Mars would find it to be a bizarre old-fashioned practice.

  • Alexander

    If this were an issue being commented on or opposed by “progressives,” the first words out of their mouths would be to reject any such statement being promoted by “the medical-industrial complex,” because pediatricians have an “obvious” profit incentive to promote circumcision.

  • Will

    I have no “skin” in this game, so to speak, but if it ain’t broke…

    http://blogs.miaminewtimes.com/riptide/2012/05/couple_sues_miami_doctor_over.php

    I wonder what the rate of botched circumcisions is. I have a feeling that these are left out of the studies.

    I once saw a story about a circumcision in the 60s or 70s where it was so badly botched that the physician suggested gender reassignment surgery. The parents agreed to raise their son as a daughter. This is how “science” thought back then–that everything came down to nurture instead of nature, it people could be easily reprogrammed by a good psychologist.

    It didn’t work out so well. The kid ended up very confused as a teenager, feeling like a boy inside, but with none of the boy parts.

  • Appledrop

    “As a woman, I will never have relations with an uncircumcized male again due to the infection I received.”

    Your partner’s lack of concern for you is regrettable. You don’t mention what kind of an infection it was but in most cases men get infections from women with poor feminine hygiene. Or simple lack of knowledge about what’s going on down there.

  • Jennifer Trias

    To those who think that routine circumcision to prevent penile cancer is worthwhile, here are some interesting numbers:

    Estimates of penile cancer in the US in 2012:
    New cases: 1,570
    Deaths: 310

    Estimates of breast cancer in the US in 2012:
    New cases: 226,870 (female); 2,190 (male)
    Deaths: 39,510 (female); 410 (male)

    So, more men will get and die from breast cancer than penile cancer.

    Sources: Sources: http://www.cancer.gov/cancertopics/types/breast
    and http://www.cancer.gov/cancertopics/types/penile

  • thibaud

    What explains Mead’s obsession with circumcision?

    Is this the fruit of some marketing strategy designed to expand his blog’s appeal to, so to speak, non-traditional demographics?

    Or a response to some personal saga too painful to reveal?

    Or is it another case of snarlin’ ol’ Mr Hyde-Mead once again indulging his spleen and attacking the imagined enemies of god-fearin’ ‘mercanism, foreskins and all?

  • John Bennett

    Science shows it is a very safe and beneficial procedure like vaccination that if anything improves sexual function. Opponents have ignored science and held up AAP’s neutral stance for support. Now that is taken away what can they do?

  • Heather

    I agree with Bill H, it’s so funny to me that my liberal friends are in my business to the max about whether or not I’m going to “mutilate” my unborn son…however, they are 100% pro-choice. My one friend, in particular, has had an abortion, which I never gave her any grief over, even though it isn’t a choice I would personally make. When I brought up the pro-choice point, it was the only point that finally shut her up (for a minute). I was thinking of bringing it up forever, but was trying to be respectful. After being attacked for a choice I haven’t even made yet, I decided to bring up the most obvious point I could. (She is also completely against hospital births, epidurals, etc., however she has done every drug under the sun–again, I never judged).
    Personally, we are leaning towards circumcision, but I still have 4.5 months to decide. People need to stop attacking everyone for their personal decisions, after all, it is their decision. I understand the argument for those who are against, when the argument isn’t a completely irrational point like “why not cut off their toes at birth to avoid ingrown toenails”, or “cut off female babies breast (didn’t know they were born with the capability of having a double mascectomy) to avoid breast cancer”. They only reason I would choose not to circumcize is because I would decide it wasn’t necessary, not because it is mutilation or cruel.

  • Dick Scalper

    They brand men like a herd of cows. American men are such wimps to let their sons be subjected to this absurd surgery. If it were women tied down & cut, the Feminists would be howling all over the world. The male genitals are a cheap commodity. There is no argument too absurd for the circumcisers. They insult the appearance of the intact penis, claim that circumcision heals everything from body warts to HIV, and draw an illogical distinction between female & male genitals. Circumcision is the mark of a slave, my friends.

  • http://twitter.com/KOTFrank Frank McGinness

    Therefor you think it okay to cut off parts of someone else’s body without their permission to age 18. Can we have our founding fathers weigh-in opinion?

    What of religious persecution with genitals in the balance? Separation of church and state? Right to person?

    Therefor you endorse scarification and sacrificing a “pound of flesh” of the genitals to mark a religious social group. In other words, you endorse the right to use the body’s of children and the adults they become as billboards of another’s religious beliefs. Would tattooing religious / gang affiliation be okay also? Even when tattooing the foreskin’s of children? No? But would be okay to do this and then cut it off, right?

  • brigitte

    There is no doubt that a competently performed circumcision is advantageous regarding reducing the risks for various types of disease incidences.
    Today with the perils of climate changes creating even short periods of disrupted services means even the affluent educated can’t presume to always have facilities for perfect penile hygiene on tap. Add the massive number of boys born to single mothers, oblivious of what would need to be taught re hygiene plus a promiscuous era. I could never subject my sons as tiny infants to circumcision. Secondly, anesthetics are detrimental to the developing brain in the earliest years reserved for critical surgical needs.It ought to be done by early teens with the consent of the boy. The boys of belligerent mothers could be done as infants as the few dots lost in IQ via any anesthetics to be more humane is marginal compared to the welfare environment they have. Ironically my uncircumcised brother then aged 19, who did forest firefighting each summer as a forester, was in a group parachute dropped in mountains to be collected a week later. His singed foreskin got infected requiring a circumcision on return. My oldest son ended up with worsening phismosis and needing a circumcision at 13. Both claim they far preferred being circumcised and did feel sore for a bit. Much of the Old Testements directives arose out of essential pragmatics to maximise healthy survival and avoid infections. It does take the fear of God as well as social acceptance/belonging needs to get observance of sensible healthy practices established. What is worrying is that with no widespread epidemological evidence doctors were outright recommending against circumcision. Rather than merely stating that any intrusive non currently essential procedure on an infant is questionable. Yet there is a need to accept that in some societies the living conditions mean circumsion is preferrable. This would mostly result in this done to infants because of problems in ensuring enough boys could access this at later ages.