Ruminations

Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Monday, April 04, 2011

Skip Newborns; Circumcise Boys?

Now does that strike one as sensible? "Circumcise older boys not newborns: expert."

To launch an informed medical recommendation for peripubertal boys to be encouraged to select for themselves a circumcision in a forward-looking attempt to decrease their future risk of contracting HIV or human papilloma virus (HPV). Rather than go the more traditional route of encouraging parents to make that decision for their newborn boys.

On the thesis that it is the boy himself who should make the informed decision, not the parents.

Professor Noni MacDonald at Halifax's Dalhousie University's pediatrics study group has published a guideline for a new male-circumcision protocol in the Canadian Medical Association Journal. Her theory is that since the protective benefits of circumcision only occur once a male has matured to become sexually active, it is not necessary to jump the gun and perform the surgery on babies.

Better to wait until they are older, and capable of making their own decisions.

Not a very good idea, actually. Although it's true that the choice to remove or retain the foreskin would then be the individual's, how likely is it that a young boy of 11, 12 or 15 would choose to voluntarily undergo surgery? A painful surgery for which there would be a lengthy period of physically restorative rest imposed upon a boy for whom physical action at that age is an imperative.

At an age, moreover, when anything closely resembling surgery is frightening and more likely to be rejected than accepted as future insurance against becoming infected with a virus that could have unfortunate repercussions. Sparing the infant to cause pain to the boy. Does that meet the criteria of common sense?

The infant's distress and pain passes, as it is given the required anaesthesia to counteract the pain. The young boy's pain in latterly undergoing a process that might have already been committed to at a time he would have no memory of it, will be one that could conceivably cause unneeded psychological trauma.

Recent trials from Africa have reached the conclusion that male circumcision has the effect of cutting the risk of acquiring HIV by roughly 60% in heterosexual men. There is also a marked decrease in the risk of contracting human papilloma virus (HPV), a virus that can cause genital warts, and penile cancer, as well.

Women whose partners have been circumcised have a far lower risk of contracting HPV and cancers, as well as any number of sexually transmitted disorders. With the foreskin removed it is much easier to achieve a good degree of cleanliness.

There has been much controversy over the past several decades of the need for and the effectiveness of male circumcision. Once done routinely in the Province of Ontario and throughout North America, it has undergone a rejection as an unnecessary and intrusive procedure, one that is not really required, in some perceptions.

Men who had undergone circumcision as babies sought to have further surgery done of a cosmetic nature to restore their foreskins, feeling that they have lost something valuable to them. On the other hand, there has also been the reality of a landslide of sexually transmitted diseases becoming ever more common in society, which circumcision could help diminish.

Infant circumcision has come under great criticism. And it has also been vigorously defended as an important hygienic tool. Studies performed at the Hospital for Sick Children in Toronto affirm that newborns undergoing the procedure without the administration of painkiller may be likely to experience a reflexive aversion later in life, lowering their pain thresholds.

The decision to have a male child circumcised should be an informed one, taking into account many important variables. For some, it is a simple matter of respecting the heritage of custom, as with Judaism. For others it represents a deliberate and offensive interference with what nature intended. This latest recommendation presents as another type of option.

As with so many other matters of public and private health concerns, there are no easy answers.

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