Published online August 31, 2007
PEDIATRICS Vol. 120 No. 3 September 2007, pp. 695 (doi:10.1542/peds.2007-1457)

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LETTER TO THE EDITOR

Primum Non Nocere

Michelle R. Storms, MD
Marquette Family Medicine Residency Program
Marquette, MI, 49855

To the Editor.—

I was dismayed to read the commentary by Dickerman¹ regarding his desire to implement mass neonatal circumcision. His arguments were based on a selective bibliography and other like-minded opinion pieces. There have been no evidence-based studies to support his assertions of the preventive value of neonatal circumcision in HIV infection. Clinicians who are actively practicing pediatrics consider the idea of circumcision preventing HIV laughable, because the United States has one of the highest circumcision rates and one of the highest rates of HIV infection. Industrialized countries in which men are left intact have much lower HIV rates than those in the US. Clinicians know that the acquisition of HIV is related to behavior and sexual practices. It is prevented by lifestyle changes and the use of condoms. This is where we need to place our emphasis.

Neonatal circumcision makes no sense from a biological standpoint. It is not plausible to remove normal, healthy neonatal tissue. Although any healthy tissue can become diseased, physicians do not routinely remove healthy tissue to supposedly prevent disease that has not yet manifested itself.

The promotion of neonatal circumcision often reflects the circumcision status of the promoters rather than the actual utility of the procedure. Intact men do not promote this procedure, because they understand the value of the foreskin and realize that it does not deserve to be demonized. Circumcised men believe that they are not missing anything, because they have never really known otherwise. Women who undergo trauma during childbirth recognize that genital trauma has a downside, because they can compare their genital function before and after delivery. Circumcised men, however, cannot recall what they had, so they presume that there were no adverse effects.

I am hopeful that, one day, circumcised men will be able to rationally, objectively confront this topic and accept that infants are people who deserve to be left whole and healthy. Most of the world agrees with this concept.

REFERENCE

1. Dickerman JD. Circumcision in the time of HIV: when is there enough evidence to revise the American Academy of Pediatrics’ policy on circumcision? Pediatrics. 2007;119 :1006 –1100[Free Full Text]

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PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Storms, M. R. Search for Related Content PubMed PubMed Citation Articles by Storms, M. R. Related Collections Office Practice Related AAP Red Book topics: Human Immunodeficiency Virus... Social Bookmarking                         What's this?