Saturday, April 9, 2011

Circumcision Timing Sparks Debate

By REBECCA WALD

Noni MacDonald, M.D.
Is circumcising an infant less traumatic than circumcising an older child or an adult? According Brooklyn mohel Rabbi Yakov Werde, circumcising at an older age is “much more traumatic.” The mohel’s comment appears in an April 7 post on the blog “The Schmooze,” which is part of The Jewish Daily Forward. At issue is a recent Canadian Medical Association Journal article “Male circumcision: getting the timing right,” which puts forth the idea that it may be better to offer circumcision to young male adolescents rather than imposing it on newborns. 
The article’s author, Noni MacDonald, M.D., is a professor of pediatrics at Dalehousie University in Nova Scotia, Canada.  Her point is a fairly simple one, which is that any potential benefit circumcision has for preventing sexually transmitted disease only kicks in when males become sexually active. If the medical specialty associations in Canada and America are going to consider changing their position statements about the benefits of circumcision, shouldn't they also consider when best to circumcise? 
Dr. MacDonald points out that circumcision causes pain and discomfort at any age and that delaying the decision until a boy is an adolescent has benefits. The boy would have the opportunity to participate in the decision. Moreover, it would be a good time to discuss other ways a young man can decrease his risk of contracting sexually transmitted disease, regardless of whether he decides to be circumcised.




For those of us who value the foreskin, the question of when to routinely amputate it seems absurd. It’s like asking: When should we cut off a person’s perfectly functioning finger, or when should we poke-out a sighted eye? For us, the answer is simple: never! However, Dr. MacDonald is functioning within the public health machine, where mechanical approaches based upon “evidence based” medicine are the standard. I applaud her for working within this system in an attempt to reduce infant circumcision and bring individual choice and informed consent to the process. 
As for Rabbi Werde’s opinion that circumcision is much less traumatic for the youngest among I us, I seriously question this. Yes, adults cannot consciously remember being circumcised as neonates, but what does memory have to do with the experience of trauma? If memory were a requirement for emotional and/or physical trauma, those who have been abused or neglected as small children, but can't remember it, would suffer no adverse consequences. We know this isn’t true. 
Any sensitive person who has had children of their own, or has spent time caring for infants, knows they are exquisitely sensitive beings. Something as trivial as gas pain brings bouts of pitiful crying. Infants probably feel things far more acutely than older children and adults because they have not had the opportunity to develop defensive mechanisms. An older child or an adult would go into the experience of circumcision with an understanding of why the procedure is to be done and knowing the alleged benefits. During and after the surgery, he would be able to discuss his pain level with his caregivers, so his pain can be adequately controlled. Conversely, a newborn knows nothing of what is being done to him, or why. During the event he cannot process in an intellectual way what is being done to him. He can only scream in anguish. He cannot understand that he will feel better soon. Nor can he discuss has happened to him with others, thereby gaining their sympathy and understanding, which is an important part in overcoming any trauma. 
When to circumcise--if one is going to get circumcised--is indeed an important question that should be well considered by any medical society making recommendations on the subject. I am thankful that Dr. MacDonald has sparked thinking and conversation on this subject, both within the Jewish community and beyond.  


© 2011 Rebecca Wald

4 comments:

  1. Rabbi Werde simply cannot know what he is talking about. Rabbis not being urologists, there is no ethical way for a rabbi to have a lot of experience with teenage circumcision and it convalescence. There are not a lot of adolescent circumcisions in the USA, and those that do take place, occur outside of the Jewish community. Finally, the rabbi seems to harbour the persistent but unspoken assumption that infant circ, even without any pain reduction, is somehow less painful, less traumatic, and easier to heal from, than circ later in life. This is a sad urban myth.

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  2. "...Dr. MacDonald is functioning within the public health machine, where mechanical approaches based upon “evidence based” medicine are the standard."

    I trust you wrote "mechanical" in a pejorative sense! I also trust you appreciate that "evidence based" is the rallying cry of Prof. Brian Morris, the Dark Lord of RIC advocacy!

    "Evidence based" can easily mean knowing something about trees but being unaware that one is walking in a forest. Evidence based forgets that a scientific study, especially with human subjects, of necessity makes a host of explicit and silent assumptions, and that the interpretation of a study hinges on the effect of those assumptions. The scientific method does not warn us when a study is poorly designed, or has overlooked the obvious. Empirical science is but one arrow in the larger quiver of human paths to understanding. I have studied a fair bit of science, and published a number of statistical studies.

    Mrs Wald, a very curious fact is that, in my opinion, the best academic writing on circumcision is by medical school profs or sexologists, but by law profs, whose mode of reasoning owes little to the scientific method.

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  3. The thing I hate most about being ethnically Jewish is the Jewish infant ritual male-organ mutilation. Living with the problem all my life, I never knew the difference. But then I realized that men are supposed to have sensation on their glans, and I only have a little sensation on that little ridge on the underside just behind the glans. As soon as a procedure is invented to allow me to get a fully functional organ, I'm getting the procedure! Shame on Judaism!

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  4. Actually, Lyutsin men are supposed to have sensation in their foreskin. That little ridge on the underside just behind the glans, the frenulum, is a remnant of the ridged band discovered by the late Dr John Taylor in 1995, that runs around the inside of the foreskin near the tip. It's richly endowed with specialised nerves, like those of the fingertips or lips. (That's why you don't kiss your aunt on the lips.) Its effect is literally sensational, conferring "a symphony of sensation" - not just "more sensitivity".

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