In this country, circumcision is the norm. According to the Center for Disease Control and Prevention, 89 percent of non-Hispanic white males in the United States are circumcised. If an American boy is uncircumcised, it generally means his parents are immigrants, usually Hispanic, or low-income.
The exception is a small number of middle-class boys whose parents have been convinced by activist anti-circumcision groups to leave their baby boys “intact,” as they call it. Parents targeted by lay anti-circumcision groups are usually well educated, secular and liberal, live in coastal “blue” states and are attracted to alternative/holistic medical practice.
Many Jews fall into this profile, so that now, thousands of years after the covenant between Abraham and God mandating circumcision on the eighth day (Genesis 17), we see Jewish boys with foreskins. The Bay Area is ground zero for activist organizations gunning against circumcision, such as NOCIRC, NOHARMM and Intact. The arguments of these cultlike groups are based on anecdotes, testimonials, false theories and bogus claims with no scientific support.
Recently, as compelling medical evidence demonstrates the significant health advantages of circumcision on newborns, there has been a flurry of desperate activity by anti-circumcision groups, as they see their cause being decimated. They picketed the local office of the American Academy of Pediatrics, and the executive director had to call the police. At an AAP meeting in San Francisco in July, I was harassed by anti-circumcision protesters, leading the hotel to assign me a security guard. This all followed last year’s unsuccessful attempt to criminalize infant male circumcision in San Francisco.
The documented evidence of the lifetime preventive health advantages of circumcision is overwhelming. This year, the AAP stated that the significant benefits of newborn circumcision outweigh the minor risks. Severe infant kidney infections, which can lead to kidney damage, are 10 times more common in uncircumcised males in the first year of life. The presence of a foreskin leaves a young boy susceptible to painful local infections (balanoposthitis) and inability of retraction (phimosis).
In sexually active years, circumcision provides 60 percent greater protection against HIV/AIDS, which has killed over 20 million people in Africa and tens of thousands in this country. The United Nations, the World Health Organization and the National Institutes of Health have all endorsed circumcision to help prevent HIV/AIDS. Other sexually transmitted infections that circumcision helps protect against are genital herpes, human papilloma virus (the cause of penile and cervical cancer), trichomonas and bacterial vaginosis. The advantages in old men include avoidance of penile cancer and urinary infections, which are prevalent in the elderly, as well as easier genital hygiene in the incapacitated.
The newborn period is the ideal time for circumcision. Not only does early circumcision lead to a lifetime of health advantages, but it is the easiest and safest time to perform the procedure. After the trauma of birth, a newborn is programmed to deal with distress. Stress hormones, such as hydrocortisone and adrenaline, are extremely high, as is the pain-relieving compound endorphin. The male hormone, testosterone, is often in the adult range. All these hormone levels fall within the first few weeks of life. The newborn foreskin is thin, making the procedure quick and safe and virtually painless when using local anesthesia. Healing is rapid, and complications, usually minor, are less than 0.5 percent.
At older ages the procedure is more difficult, with a longer recovery time and a tenfold higher complication rate. The need for general anesthesia makes the procedure riskier. Almost all circumcision deaths have been due to complications from general anesthesia.
As noted, uncircumcised males, compared with those who are circumcised, are prone to many health dangers from birth through old age, and also may have social problems in the United States, where circumcision is the standard. In addition, the easier genital hygiene leads to improved and more varied sexual relations. Above all, Jewish men with foreskins are abandoning an ancient family tradition and culture.
My advice for anti-circumcision Jewish parents is, “enough already.”
Dr. Edgar J. Schoen is the former chief of pediatrics at Kaiser Permanente in Oakland and clinical professor of pediatrics, emeritus, at UCSF. He lives in Richmond.