Source: www.circinfo.org | Original Post Date: April 10, 2016 –
AAP waves white flag as Vikings storm fortress circumcision
The case for circumcision has been dealt a final, fatal blow. Danish research showing that the vast majority of normal (uncircumcised) boys never experience any “foreskin problems”, and that only a tiny minority of boys with a problem require circumcision to fix it, has forced the American Academy of Pediatrics to admit that the case for routine (prophylactic) circumcision is empty and bankrupt. The key facts from the paper by Ida Sneppen and Jorgen Thorup, are as follows:
- 5% of boys (aged 0-18) experienced a foreskin-related problem (mainly phimosis, BXO and frenulum breve).
- 1.7% of boys required surgery to correct the problem.
- 0.4% of boys required circumcision to correct the problem.
95 per cent of uncircumcised boys will never experience a foreskin problem
What this really means is that:
- 95% of boys will never experience a foreskin problem.
- More than 98% of boys will not need foreskin-related surgery (mainly because most foreskin problems, especially phimosis, can be addressed by non-surgical means, such as topical medication).
- Only a tiny minority of boys (less than half a per cent) will need to be circumcised because their particular foreskin problems are not amenable, or did not respond, to medical treatment.
The paper also noted that meatal stenosis (narrowing of the urethral opening) is 3 times more common in circumcised boys.
This website pointed out some years ago that 93% of Aussie boys would never experience a foreskin problem, and thus that routine circumcision makes no medical sense at all. This latest, comprehensive Danish study confirms this assessment, and further shows that only a small minority of the unlucky few who do experience problems will require surgery. The case for precautionary circumcision in advance is now well and truly dead and buried.
Source: Ida Sneppen and Jorgen Thorup, Foreskin morbidity in uncircumcised males, Pediatrics 137 (5), May 2016. Advance access 6 April 2016
Waving the white flag:
Astonishing admissions from American Academy of Pediatrics
In response to this devastating avalanche of scientific evidence, the AAP has more or less conceded that its 2012 circumcision policy was not really concerned with the medical case for circumcision at all, but with cultural and religious issues. In an editorial accompanying the Sneppen/Thorup paper, Andrew Freedman, a member of the circumcision policy taskforce, makes the following amazing admissions:
- Circumcision is basically and usually a religious or cultural preference on the part of the parents, not a medical decision.
- Parents and medical advisers use medical evidence selectively to bolster their prior ideological positions on circumcision.
- We did not recommend circumcision.
- Circumcision is not necessary for optimum health.
- Underlying aim of 2012 circumcision policy was to counter proposals to prohibit non-therapeutic circumcision of minors.
- “Given the role of the phallus in our culture”, it is legitimate to consider non-medical factors in the circumcision decision.
- Not all penises have to look the same.
- The risk/benefit equation we devised (“benefits outweigh risks”) is applicable and relevant only to those who have non-medical (cultural, religious, social) reasons for circumcision.
Source: Andrew Freedman, The circumcision debate: Beyond benefits and risks. Pediatrics 137 (5), May 2016. Advance access 6 April 2016.
The obvious questions arising from Dr Freedman’s admissions are:
1. If circumcision is not a medical procedure, is not recommended and is not necessary for health, and if it is primarily a religious, cultural or social ritual, how can the AAP justify its recommendation that it is legitimate for health insurance providers to fund it?
2. Given the above, plus the acknowledged non-medical significance of the penis in our culture, how can the AAP justify its assumption that it is the parents, rather than the owner of the penis, who are the appropriate parties to make the circumcision decision?
We must point out that it was Freedman who, when the AAP policy was under attack back in 2012, notoriously stated that he did not circumcise his own boys for medical reasons, but because he felt the weight of centuries of ancestors breathing down his neck. It is evidence of his continuing commitment to circumcision as a cultural/religious rite that he makes no mention of bioethical or human rights issues, such as the child’s right to an open future; nor does he acknowledge that the AAP’s risk/benefit calculation has been criticised as empirically false, conceptually misconceived and inadequate to the complexity of the “circumcision decision”. Despite the title of his editorial, Freedman has not gone far enough beyond “benefits and risks”.
The key point is that those who have sought to advocate or defend circumcision (whether for cultural or medical reasons) on the basis that the AAP had guaranteed the soundness of the health case in its favour now find that the cheque has bounced. The fact is that the AAP bank account is empty. The last remaining bastion of respectable circumcision advocacy has been the American Academy of Pediatrics; now that their fortress has been stormed by a devastating Viking raid, the case for circumcision is well and truly on its last legs.
Effect of circumcision on incidence of sexually transmitted infections
OK, you may be thinking that even if very few uncircumcised boys experience a foreskin-related disability when young, but what about the other supposed health benefits of circumcision emphasised by the AAP and other advocates, such as reduced risk of sexually transmitted infections as an adult. We have sought to put that canard to rest as a piece of medical folklore on several occasions, but it persists. To show how wrong it is, here are comparative statistics for HIV, gonorrhoea and syphilis in (uncircumcised) Denmark compared with the (circumcised) United States:
Denmark: 0.1-0.2% (2014, adults 15-49)
United States: 0.4-0.9% (2012)
Denmark: 12.1 per 100,000 (2012)
United States: 110.7 per 100,000 (2014)
Denmark: 6.1 per 100,000 (2012)
United States: 6.3 per 100,000 (2014)
So the (circumcised) United States has 4 times the level of HIV, and 10 times the level of gonorrhoea as (uncircumcised) Denmark. This suggests that the foreskin is protective against, and circumcision increases the risk of, urinary tract infections such as urethritis and gonorrhoea, at least in adulthood – which is what Jonathan Hutchinson found in 1855, and Ferris et al in 2010.