Parents face tough choices if they disagree on the issue of circumcision. Suite101 asked the American Academy of Pediatrics spokesperson and pediatrician Vandana Bhide about the pros and cons of this type of surgery, how it is conducted and the AAP's stance on circumcision. With new evidence suggesting that circumcision offers new health benefits, for the first time ever, the CDC is preparing to issue recommendations that could be, in direct oppostion to the AAP's.
A Heated Debate – Parents and Doctors Often Disagree
Outside of religious beliefs, circumcision can be a monumental decision for many parents. When opinions on circumcision differ between partners, a battle of wills can ensue not served by an equally divided medical field. When doctors disagree, the confusion between parents grows deeper. Fueled by divisive research, medical or otherwise, parents quickly realize that a final decision on circumcision may be influenced by the strength of personal convictions.
Until 1999, the American Academy of Pediatrics, AAP, routinely recommended circumcision before switching to a neutral stance which the academy reaffirmed in 2005. A study, "Circumcision: We Have Heard From the Experts; Now Let's Hear From the Parents," that appeared in Pediatrics Vol. 107 No. 2 in February 2001 – the official journal of the AAP – concluded that two factors emerged to influence parents about the decision to circumcise: finance and lack of information. Consequently, the neutral stance adopted by the AAP, led to some insurance companies refusing to fund the surgery.
The Push for Circumcision Seems Imminent
Circumcision rates have been in decline. After a peak of about 80% in the 1960s, the newborn male rate for circumcision now sits at around 56%. In January 2010, the circumcision debate heated up further with media reports that the US Centers for Disease Control will, for the first time ever, issue a statement on circumcision recommendations. These recommendations will be based upon new research that indicates the procedure may have newly recognized health benefits.
The CDC says that while "recent reports have speculated about the Centers for Disease Control and Prevention’s (CDC's) upcoming public health recommendations on male circumcision for HIV prevention in the United States," The "CDC’s final circumcision recommendations will be completely voluntary." Possibly indicating, that the CDC will eventually endorse circumcision as a preventative procedure. Whether the AAP will follow suit in light of the new evidence remains to be seen.
With an increasing emphasis on children's rights, opponents of circumcision include medical associations, parental groups and organizations calling for a protection of both children's and men's future rights. In May 2010, the Royal Dutch Medical Association, citing the protection of children's rights, called for a ban on non-therapeutic circumcision.
Dr. Dean Edell, author of the book, Life, Liberty and the Pursuit of Healthiness, issued a statement in Feb. 2010 at Drmomma.org, announcing his "vociferous opposition to the practice of routine male circumcision." Dr. Edell discusses several myths surrounding circumcision, including the AAP's rate on circumcision complications being at least one in 100. Furthermore, Dr. Edell says, referring to a circumcision study that ended early due to infant trauma, "Newborns experience extreme pain and significant stress during a circumcision which, unfortunately, is performed most of the time without any analgesia whatsoever."
A Parent's Decision is Often a Lonely One
Couples disagreeing about the decision to circumcise really do tread a solitary path when at odds with one another. In June, 2006, the Times newspaper reported on a divorced couple from Chicago in complete disagreement about the issue of circumcision. The father adamantly opposed the "barbaric" procedure and consequently sued his ex-wife in court. In another 2007 court case, James Boldt, a convert to Judaism, was given permission by lower-courts to circumcise his son after his ex-wife objected.
What can parents do to make an informed decision in light of conflicting and often volatile rhetoric? The Circumcision Decision Maker is a tool parents and adult men might utilize in weighing up the pros and cons of circumcision. Some say that the tool is biased towards anti-circumcision, readers can choose for themselves. Another factor to consider is surgery risks. American Academy of Pediatrics spokesperson and pediatrician, Dr. Vandana Bhide, told Suite101.com that the main "risks of circumcision include bleeding, infection and pain."
The procedure, she says, "Should never be done before 24 hours of age because babies are born with an immature liver and do not have adequate vitamin K stores (made by bacteria in the gut, which do not colonize the gut until several days after birth), which is required for the liver to make clotting factors. All babies are given a shot of vitamin K at birth and this helps prevent bleeding complications."
While Dr. Bhide acknowledges that "it does decrease the risk of penile cancer and the spread of HIV," which may be relevant in African countries with a high rate of HIV, the AAP, currently "feels that circumcision is an optional procedure that does not need to be done for medical reasons." As to the procedure itself, Dr. Bhide says, "Use of the Gomco device and the Plastibell are the most commonly used procedures by physicians."
It is often the nature and method of the procedure that many parents resent, fearing the pain inflicted on their newborn. Dr. Bhide says that, "Sugar water has been shown to decrease the pain of circumcision and vaccines in babies. A dorsal penile block with a numbing agent such as lidocaine is recommended to help treat the pain of circumcision. General anesthesia is recommended if the baby is over one month of age at the time of circumcision."
Even with the use of anesthesia, babies still have to endure a certain amount of pain; either prior to the procedure or post procedure and until this changes, opponents to circumcision perhaps have a valid medical argument for the protection of children's rights.
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