Are you REALLY SURE you want your OB/GYN to cut your little boy?

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?

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31 thoughts on “Are you REALLY SURE you want your OB/GYN to cut your little boy?”

  1. You are quite correct. Doctors who circumcise do not understand what they are doing.

    Here’s an example:
    Three years ago, a 4th year medical student at the U of Chicago told me that he had been taught nothing about foreskin in class and there was nothing in his medical texts. He had done a couple circumcisions in his OB rotation. He told me that his wife had delivered their first child 6 days earlier and that he had consented to his son’s circumcision simply because he had been circumcised. He then shocked me by saying that he had never even seen a foreskin in his entire life! I replied that if he had done some circumcisions, he obviously has seen some foreskins. Taken aback, he said that except for the babies he circumcised and maybe a few other newborns, he had never seen a foreskin and certainly never seen an adult foreskin. I asked the chief of Ped. Urology at the U of Chicago at that time, Dr. Clare Close, how it can be that a 4th year medical student could tell me he had never even seen a foreskin in his entire life. She told me that medical students are not required to do a rotation through Urology and there isn’t enough time to teach them everything. Then she sheepishly shrugged her shoulders. I replied, “You mean there is enough time to teach medical students how to do a circumcision, but not enough time to tell them that no national or international medical organization in the world recommends it and no other country in the world circumcises the majority of their baby boys without claiming religion as the justification?” Dr. Close responded by shrugging her shoulders again. BTW, the U of Chicago claims to be “At the Forefront of Medicine”.

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  3. “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. ”

    But WHY? WHY are they expected to do this?

    Unless I am mistaken, most surgery must be performed because there is a compelling medical indication for it. In most other cases, performing unnecessary surgery on a non-consenting individual constitutes medical malpractice. Charging money to perform non-medical procedures on non-consenting individuals constitutes medical fraud.

    Without any medical indication present, how is it that anybody that calls himself a medical practitioner can be performing circumcisions in healthy, non-consenting children, let alone be presenting parents with the option in the first place?

    What other non-medical elective surgery can be performed solely based on a parent’s whim?

    WHY are medical students being taught CIRCUMCISION, but not presence and functions of the foreskin itself? What other part of basic human anatomy is taught, beginning with how to destroy it? Are breasts taught as “those mammary glands women are born with that are amputated during a mastectomy due to cancer?” Are the labia ever taught as “those extra flaps of skin that are removed during a labiaplasty?” Really? I mean, what absolutely backwards thinking!

    What a disgrace. What a blight on modern American medicine that this is taught in medical schools today!

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    1. I’m sure there will be a few who will have the courage to inform parents that there are no benefits and many adverse effects, and refuse to perform unnecessary surgery on nonconsenting infants. Many won’t, though, unfortunately.

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  4. I’m a Registered Nurse (4yrs practicing) and I can tell you that my whole class was taught about foreskins and functions in depths. I know that nursing school is not as in depth as medical school but we cram just as much information in as small amount of time. Nurses might not know how to do all the surgeries but we know just as much about the body functions, reactions, and whys.

    My son is not circumcised. I decided this against my husbands wishes because you don’t cut anything off of little girls when they are born and you are not born with “spare” parts. Every organ has a purpose. Where it is obvious you can live without every organ in your body, there is still a function for it and it is there for a reason. Why take out a kidney because you can and have a spare?!?! That doesn’t even make sense.

    I have seen circumcisions and I can tell you, it is not pleasant. Babies screaming while being mutilated, strapped down to a plastic form, helpless to stop the pain (and there is no pain medication given) is just horrifying.

    My husband tried to give me that “I’m circumcised” speech and I shut it down. Little boys see many penises during gym at school and every one is different. For every article about uncircumcised penises causing cancer and what for, there are several saying that its not true. I wish more people would do their own research and make their own informed decisions.

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  5. Thank you Dr. Pate! I am deeply grateful to know that you are speaking out against this insanity daily inflicted upon helpless babies. Since you are practicing among those performing circumcisions, perhaps you will be listened to by some of your peers. I think circumcisions are pushed onto parents because there is much money to be made from the surgery and the sale of foreskins. Also, the doctors performing the operations are ignorant as to what they are even doing, and not taught about the amazing value of the foreskin to the sex life of both males and females, as well as the protecting properties of the foreskin (it is NOT an infection waiting to happen!), and care of the intact young penis (never retract!). They know nothing about what they are doing, yet are performing harmful genital reduction surgery on a newborn! Many people choose to do what the doctor says rather than research something. They figure the doctor is the expert. I can’t understand why people don’t see the obvious, that amputating healthy body parts from a baby or child is horrific child abuse and makes no sense whatsoever.

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    1. I have a very strong oipinon on circumcision and I am glad you wrote this! I also wrote an entry on my blog that had some things about circumcision. I cringe when I see or hear women say that they are going to circumcise because it’s unhygienic not to. I’ve also heard someone say that an uncircumcised penis was gross (yes, she was a grown woman, and pregnant). This is one of those topics that I could argue about for hours. I just wish more people would do research and become informed before making such a huge decision!

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  6. In New Zealand, an important part of the way circumcision was extinguished was by ending solicitation. The great majoirty of boys were circumcised in the 1950s, but by about 1976, a “sleeping dogs” policy of not offering it was almost universal. By the end of the century it was almost unknown (except among the children of Pacific Island immigrants).

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  7. Strandjord bears out what I have been claiming for decades — American medicine merrily chops foreskins off without having any idea of what an adult foreskin even looks like, much less how it functions.

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    1. How odd to see an article about the suigacrl removal of a normal part of the human anatomy without any reference to what that part is or does. Imagine an article about blepharectomy* (removal of the eyelids) without any reference to what eyelids do. *The operation appears to be extremely rare, and followed by repair.If circumcision were unknown until now and someone suggested it, there would be outrage, especially at the idea of doing it to newborns. It is only because it is already so common that it is allowed to continue.See also .

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    1. Lauren, I’m so glad you posted this. So many pelpoe just do it because it seems like the thing to do . I researched it a lot before the birth of my son and we chose not to do it. Even the doctor told me that there is really now not a huge medical reason for doing it as previously thought. I’m so glad we skipped it! Those first weeks are hard enough without having to add the worry of cleaning something else and risk of infection. But, I think it is important for everyone to make a decision they are comfortable with and not be pressured either way by doctors or family.

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    1. As one of the unfortunates that were cuhgat up in the circumcision frenzy many years ago, it is important to remember that this is a surgery inflicted on another for asthetic reasons (primarily). Many comment that no man ever is upset with being cut. I for one stand for the many unfortunates who actually am upset that parents were not properly informed.Today, it is the responsibility of the physician to properly inform parents in order to provide informed concent. As a medical professional, please do not present the cosmetic side to this barbaric proceedure. Many wish that this never happened to them.Luckily, news is out on this and the rates have fallen precipitously over the last several years. Less than half of newborns are being put into harms way with this and the locker room syndrom we always hear being used to perpetuate circumcision may hopefully accelerate the decline as more are left whole.Never forget that the one being victimized will one day require justification for such an invasive procedure. Hopefully the deciding factor will be justified beyond cosmetic reasonings.

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