Circumcision remains highly marketed at the hospital I mentioned in an earlier post. Although there were at least 3 of us who did not want to perform circumcisions at the beginning of my residency, I remain the only one who has stood my ground. Many residents do not want to do them but do not have a “moral objection” and thus feel they must so as to not shift their work onto other residents. New medical students rotating through labor and delivery are expected to ask new mom’s if they want their sons to be circumcised and to chart it in their notes. There is no discussion about the controversial nature of this procedure nor the option stated that they have the right to opt out. Medical students in particular are less likely to rock the boat because they know that their grade depends on it. It is quite frustrating to me to see how resistant people are to change and how easily people cave-in to peer pressure.
I am especially frustrated that OB/GYN residents and providers continue to feel that they are competent to perform the procedure.The tradition of OB/GYN physicians performing male infant circumcisions began many years ago when they used to deliver babies in the homes of their patients and was born out of convenience; after delivering the baby it seemed appropriate to go ahead and perform the desired circumcision as well. Nowadays the vast majority of deliveries by OB/GYN physicians occur in the hospital with pediatricians and other specialists readily available so convenience is no longer an valid argument. Moreover, OB/GYN residents in general receive scant education in the anatomy and pathophysiology of the penis. Those that choose to perform circumcisions are essentially performing the “simple” procedure without the associated medical knowledge required of all other surgical procedures. And unlike other surgical procedures, the postoperative follow-up and management of complications are performed by pediatricians and other specialists instead of the OB/GYNs who performed them.
A recent article by Dr Brian Le, MD found that while the majority of 27 respondent obstetric-gynecology residents “planned to perform neonatal circumcision when in practice, 44% had no formal training in circumcision and most were comfortable performing routine neonatal circumcision. Overall respondents were less comfortable evaluating whether the a newborn penis could undergo circumcision safely. When presented with 10 pictures of penises and asked to determine whether the neonate should undergo circumcision, 0% of respondents correctly identified all contraindications to neonatal circumcision with an average of 42% of contraindications identified correctly.” (Le B. Mickelson J. Gossett D. Kim D. Stoltz RS. York S. Sharma V. Maizels M. Residency training in neonatal circumcision: a pilot study and needs assessment. Journal of Urology. 184(4 Suppl):1754-7, 2010 Oct.)
I recently performed a Medline Ovid search (looking for primary literature) and found that while there are over 50,000 articles in OB/GYN’s two most respected journals — Obstetrics & Gynecology (aka the Green Journal) and the American Journal of Obstetrics & Gynecology (aka the Gray Journal) — only 43 of these articles address male circumcision. Thus OB/GYN physicians write only 1.1% of the articles relating to male circumcision and represent only 0.076% of the articles they produce. Finally, the American Congress of Obstetricians & Gynecologists (ACOG) continues to reject exhibition of circumcision dissident materials by Intact America at their national conferences because ethical consequences of this procedure are apparently “beyond the scope of the practice of obstetrics and gynecology.”
In summary, while OB/GYN physicians have a long tradition of performing male infant circumcision and many continue to be more than happy to take a whack at infant penises, there is mounting evidence that they are deficient in the medical knowledge required to do so safely, they are uninterested in learning how to improve their skills and they do not contribute to respected literature to perfect techniques. Are you REALLY SURE you want your OB/GYN to cut your little boy?
- 10/19/11 – Georganne Chapin – End the barbaric cutting of baby boys
- 9/3/11 – Newborn male infant circumcision declining in U.S. says CDC
- 6/24/11 – The professional imperative for obstetrician-gynecologists to discontinue newborn male circumcision.
- 1/11/10 – End genital mutilation now
- 11/26/10 – Doctor and hospital sued for circumcision
- 3/24/10 – Say NO to infant male circumcision!
- 1/11/10 – Throwing wrenches at the gears