University of Johns Hopkins
Male circumcision is defined as a surgical procedure in which the prepuce of the penis is separated from the glands and excised. (Mosby, 1986) Dating as far back as 2800 BC, circumcision has been performed as a part of religious ceremony, as a puberty or premarital rite, as a disciplinary measure, as a reprieve against the toxic effects of vaginal blood, and as a mark of slavery. (Milos & Macris, 1992) In the United States, advocacy of circumcision was perpetuated amid the Victorian belief that circumcision served as a remedy against the ills of masturbation and systemic disease. (Lund, 1990) The scientific community further reinforced these beliefs by reporting the incidence of hygiene-related urogenital disorders to be higher in uncircumcised men. Circumcision is now a societal norm in the United States. Routine circumcision is the most widely practiced pediatric surgery and an estimated one to one-and-a-half million newborns, or 80 to 90 percent of the population, are circumcised. (Lund, 1990) Despite these statistics, circumcision still remains a topic of great debate. The medical community is examining the need for a surgical procedure that is historically based on religious and cultural doctrine and not of medical necessity. Possible complications of circumcision include hemorrhage, infection, surgical trauma, and pain. (Gelbaum, 1992) Unless absolute medical indications exist, why should male infants be exposed to these risks? In essence, our society has perpetuated an unnecessary surgical procedure that permanently alters a normal, healthy body part.
This paper examines the literature surrounding the debate over circumcision, delineates the flaws that exist in the research, and discusses the nurse's role in the circumcision debate.
Review of Literature
Many studies performed worldwide suggest a relationship between lack of circumcision and urinary tract infection (UTI). In 1982, Ginsberg and McCracken described a case series of infants five days to eight months of age hospitalized with UTI. (Thompson, 1990) Of the total infant population hospitalized with UTI, sixty-two were males and only three were circumcised. (Thompson, 1990) Based on this information, the researchers speculated that, "the uncircumcised male has an increased susceptibility to UTI." Subsequently, Wiswell and associates from Brooke Army Hospital released a series of papers based upon a retrospective cohort study design of children hospitalized with UTI in the first year of life. The authors conclusions suggest a 10 to 20-fold increase in risk for UTI in the uncircumcised male in the first year of life. (Thompson, 1990) However, Thompson (1990) reports that in these studies analysis of the data was very crude and there were no controls for the variables of age, race, education level, or income. The statistical findings from further studies are equally misconstruing. In 1986, Wiswell and Roscelli reported an increase in the number of UTIs as the circumcision rate declined. By clearly leaving out "aberrant data", the results of the study are again very misleading. In 1989, Herzog from Boston Children's Hospital reported on a retrospective case-control study on the relationship between the incidence of UTI and circumcision in the male infant under one year of age. Here too, the results were not adjusted to account for the variables of age, ethnicity, and drop-out rate of the participants. It is obvious that this research is statistically weak and should not be the criteria on which to decide for or against neonatal circumcision.
Lund (1990) reports that a study conducted by Parker and associates estimates the relative risk of uncircumcised males to be double that of circumcised males for acquiring herpes genitalis, candidiasis, gonorrhea, and syphilis. Simonsen and coworkers performed a case-control study on 340...