Male circumcision has a cost

September 6th, 2012 § 0 comments

I have two boys and neither of them are circumcised. Despite the recent decision by the American Academy of Pediatrics to encourage circumcision I do not have any regrets about our decision. The arguments in favor follow a common pattern that ignores any downside that is hard or impossible to quantify. Mental health is currently very hard to quantify and arguably impossible for those of us that can not talk. By assuming that there is no harm, mental or otherwise, in circumcising baby boys then any measurable benefit means it should be encouraged.

Rob Stein covered the recent AAP policy shift for NPR. Back in 1999 the organization actually backed away from circumcision.

The statement, and accompanying technical report, marks the first revision of the organization’s position since 1999, when the academy backed away from circumcision. At that time, the group, which represents about 60,000 pediatricians nationwide, concluded that there was no clear evidence for or against circumcising newborns.

The AAP is justifying this shift by citing research like the controversial studies in Africa regarding HIV transmission rates among circumcised men.

“It drops the risk of heterosexual HIV acquisition by about 60 percent. It drops the risk of human papillomavirus [HPV], herpes virus and other infectious genital ulcers,” she says.

It also reduces the chances that men will spread HPV to their wives and girlfriends, protecting them from getting cervical cancer.

I don’t want to digress into a debate about the validity of a study but rather address the lack of concern for the mental health of the newborn. It’s the same attitude that has led to some rather barbaric birth procedures where the newborn is treated as a lump of flesh that will not remember this event so any pain or trauma will have no lasting effect. Physical health is top priority and mental health is an inconvenience. I do not believe this to be true and until we can actually quantify it I believe it to be the physician’s equivalent of a moral hazard.

Baby to doctor “Wait, you are going to do what to my who?!?!?”  |   Photo by Matt Rourke/AP

Our brain is not a filing cabinet of memories that we refer to every time we make a decision. Any parent can tell you that we are a much more trainable species than we may want to believe. Ask a survivor of PTSD and they will tell you that it’s not just the memory of the trauma that haunts them. Nightmares and sleepless nights, sounds and smells that remind them of the trauma. We are shaped by a myriad of factors and active memory is but a portion of that. I’m not saying that circumcision is going to give your son PTSD, I’m saying that there is a risk benefit analysis that should not be ignored.

As parents we are constantly having to balance the happiness of our children between short and long term. Right now they will be happy if they watch TV for two hours or eat a bag of candy before dinner. In twenty years they will be unhappy if they can’t entertain themselves without a flickering screen and bag of pork rinds. I will not pretend to know how big the mental cost for circumcision is but I do know that through proper education I can do a better job of preventing my sons from getting STDs.

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