The reforming zealots are at it again! This time their latest cause is infant male circumcision, a procedure that has been practiced in western culture for thousands of years. Making their case that infant male circumcision “mutilates” the boy child in the same way that female circumcision mutilates girls, the group Male Genital Mutilation (MGM), which hails from San Diego, is seeking to place a measure on Santa Monica’s 2012 ballot that would make infant male circumcision, including circumcisions done for religious purposes, illegal and the doctors and mohels who perform circumcisions guilty of a misdemeanor and subject to a year in jail and a $1,000 fine.
Banning circumcision is a bad idea and hopefully will not qualify for the ballot in this city. As a Santa Monica pediatrician, I have done hundreds of circumcisions over my career. As a potential future felon, I know my crime well. My style is not to “push” the procedure on my patients, but if families press me for a recommendation, I do explain to them the medical benefits of circumcision, but emphasize that it should be considered an option, not a requirement.
Here’s how I present the issue to my patients:
First, cleanliness is a factor in the lives of young boys. Circumcised penises are cleaner than uncircumcised penises and infections do occur under the prepuces of little boys. These infections, called balanitis, can be quite painful and often require drainage and antibiotic treatment. Boys who are circumcised do not have to worry about balanitis.
Second, boys who are uncircumcised can experience an event, thankfully rare, in which the foreskin, when “rolled back,” becomes circumferentially entrapped around the head or glans of the penis. We call this situation “paraphimosis.” When this happens, the head of the penis becomes grossly swollen and an emergency circumcision is required. If there is a delay in resolving this problem, dry gangrene of the penile head can occur. Boys who are circumcised do not have to worry about paraphimosis nor do they have to worry about their penises becoming gangrenous. (Perish the thought!)
Third, as men age and become sexually active, the potential of infecting their sexual partners with sexually transmitted diseases (STDs) increases in men who are uncircumcised. Viruses and bacteria hide under the uncircumcised prepuce. HIV, in particular, has been shown to live longer under the uncircumcised foreskin and it is now becoming a common practice in sub-Saharan Africa for uncircumcised men to undergo circumcision in an effort to decrease the HIV transmission rate in countries that are struggling with the AIDS epidemic.
Fourth, infant male circumcisions done in hospitals are performed under sterile conditions after the child has received a local nerve block. Done with either a Gomco clamp, Mogen clamp or plastic bell around the penile glans, the procedure is safe and well tolerated. Complications are exceedingly rare.
Fifth, circumcision is often performed for religious reasons. The Jewish faith commands that their male children undergo circumcision on the eighth day. Performed by mohels in a ceremony called a brit milah, circumcision is a solemn confirmation of the Jewish faith. Many Christians also circumcise their male children for religious reasons as well. Outlawing the procedure would represent a literal frontal attack on these religious practices. The First Amendment of the United States Constitution protects against such governmental tampering with religion. But if the procedure was “outlawed” in Santa Monica, legal challenges would undoubtedly arise.
Sixth, the American Academy of Pediatrics has chosen to not officially endorse circumcision. The AAP does, however, recognize the medical value of circumcision, but wisely recommends that the procedure be the personal choice of the family. This official position is a far cry from banning. Another issue the academy considers in their recommendations is cost. If the academy did issue a blanket recommendation for circumcision, the cost of medical care would increase substantially for a procedure that is optional.
Finally, equating female circumcision to infant male circumcision is utterly ridiculous. Female circumcisions, which remove the entire clitoris, are done with the malicious intent of denying women the pleasures of sexual relationships. Female circumcision often results in substantial perineal scarring, interference in normal urination and painful and joyless sex. This is not the case with male infant circumcision in the least.
Circumcision is a procedure that has long-standing precedence in western culture. Santa Monica should not be tempted to enter this fray and voters should not sign the MGM petitions. Instead, the citizens of Santa Monica need to resist MGM’s attempt to interfere with our medical and religious circumcision practices by chasing these wrong-headed, carpet bagging shills out of town … with Gomco and Mogen clamps in hand.
Dr. Robert C. Hamilton is a pediatrician with a practice in Santa Monica who, along with the Lighthouse Medical Missions, organizes trips to Africa to provide critical medical care to those living in poverty.