PEDIATRICS Vol. 120 No. 3 September 2007, pp. 695-696 (doi:10.1542/peds.2007-1477)
LETTER TO THE EDITOR |
Internal Medicine/Pediatrics
Statesboro, GA 30458
To the Editor.—
I fear that Dickerman may have lost sight of our responsibility as physicians: primum non nocere.1 His recent commentary2 advocating a change in the American Academy of Pediatrics policy on circumcision is ill-founded. His view that a decline in the prevalence of infant circumcision is "very disturbing" unfortunately shows how much more education infant advocacy groups need to perform to accomplish a ban on newborn male genital mutilation.
There is no role for the routine amputation of an infant boy's foreskin. Dickerman fails to mention a single foreskin benefit in the intact male, but there are many (see the Circumcision Information and Resource Pages at: www.cirp.org). The foreskin is not a useless piece of tissue that can be cut off and discarded without regard.3 Were circumcision reimbursement halted by third-party payers, the "necessary" surgical procedure would soon fall to negligible levels. Most reasonable health professionals are appalled by female genital mutilation yet are unfazed by male genital mutilation. Sadly, many consider circumcision just another 10-minute billable procedure for which their accounts receivable balance rises by another $150.
If circumcision is beneficial and affords the "best protection," should not the patient be allowed to decide what best serves his purpose? The vast majority of men in my practice who were circumcised after the age of consent almost universally describe sexual activity as less pleasurable and over time develop some form of erectile dysfunction.4 Most of them, if given the choice again, would not consent to circumcision.
No newborn can give consent for any surgical procedure, the least of which is a cosmetic procedure with dubious benefit.5 Circumcision should only be performed on a man who has reached the age of consent and has carefully weighed his available options.6
I urge the American Academy of Pediatrics to reject any policy statement that calls for circumcision. In fact, I ask the academy to extend its advocacy of newborns to ban any infant genital mutilation regardless of the infant's gender.
REFERENCES
- Durnford J. Primum Non Nocere: "First Do No Harm"—An Ethical Reflection of the Issue of Male Infant Circumcision. San Francisco, CA: National Organization to Halt Abuse and Routine Mutilation of Males; 1996. Available at: www.noharmm.org/primum.htm. Accessed July 10, 2007
- 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] - Whose Body, Whose Right? Examining the Ethics and the Human Rights Issue of Infant Male Circumcision [videotape]. San Francisco, CA: Dillonwood Productions; 1995
- Sorrells ML, Snyder JL, Reiss MD, et al. Fine-touch pressure thresholds in the adult penis. BJU Int. 2007;99 :864 –869[CrossRef][Web of Science][Medline]
- Doctors Opposing Circumcision. The use of male circumcision to prevent HIV infection. Available at: www.doctorsopposingcircumcision.org/info/HIVStatement.html. Accessed July 10, 2007
- Declaration of the First International Symposium on Circumcision. Available at: www.cirp.org/pages/intactivist/declaration. Accessed July 10, 2007
PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics
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