I was saddened by Victor Schonfeld’s emotional attack on brit milah (“Circumcision – Defending the Undefensible,” The Jerusalem Post, January 22, 2014), calling it an indefensible, brutal anachronism.
I really was saddened to read about his unfortunate personal experience with the circumcision of his son. If we compare personal experiences, I have participated at close quarters in the circumcision of four sons, 26 grandsons, and so far some 30 great-grandsons, and have never noted more than a few short moments of crying, quickly ended after sucking on a bit of wine and relaxing in mother’s arms.
But neither his nor my experiences provide the data upon which parents should decide whether or not to circumcise their infant sons. As a physician-scientist who is a firm devotee of “evidence-based medicine” and who has followed the medical literature on the subject for decades, I think that by now rational decision making clearly favors circumcision, during infancy.
The American Academy of Pediatrics studied the subject for several years, reviewing thousands of research papers published over a 15-year period, and in its latest report in 2012, stated unequivocally that the preventive benefits of circumcision outweigh the risks.
The American College of Obstetricians and Gynecologists endorsed this position, as did the Mayo Clinic.
The World Health Organization is sponsoring massive campaigns in Africa because of the dramatic reduction of HIV infections in circumcised individuals.
Let us examine some of the facts.
Cancer of the penis affects between 1 in 500 to 1 in 1000 uncircumcised men during their lifetime, and has a 50 percent mortality. It is virtually non-existent in males circumcised in infancy. This is related to the oncogenic human papilloma virus, which thrives in the environment covered by the foreskin. Uterine cervical cancer in women seems higher as well in partners of uncircumcised men, and there is a hint of possible involvement of the virus in prostatic cancer.
Randomized, carefully controlled studies have shown that circumcision dramatically reduces the risk of HIV infection, and as a result the World Health Organization has launched major drives for circumcision in Africa, aided by physicians from Israel. In our globalization era diseases such as AIDS are not confined by continent, and the argument that these studies are relevant only to Africa simply is unfounded.
But other sexually transmitted diseases such as syphilis, herpes type 2, chancroid, trichomonas and candida are also favorably affected by circumcision. Urinary tract infections in infants are 10 times more common in uncircumcised infants, and while these infections are not frequent, they can lead to serious complications. The lifetime risk for a man to have a urinary tract infection is four times as great in an uncircumcised male over one who has been circumcised.
Circumcision in infancy also prevents many local infections of the penis, which frequently require circumcision later in life, a procedure more complicated than during infancy.
The risks of the procedure as performed by an experienced mohel or physician are generally minor, and almost never life-threatening. I functioned as ombudsman for Israel’s National Health Service for over a decade, during which time well over 500,000 infantile circumcisions were performed in Israel, and all the complications brought to the attention of the ministry. There were no deaths, and only a small number of minor complications which rarely required hospitalization.
Much of the literature attacking infant circumcision tries to convince us that a few moments of pain during this procedure has long-lasting effects on the psyche of the individual. The evidence for this is non-existent. And any parent of a normal boy can attest to multiple injuries that boys undergo during infancy and childhood which are far more traumatic than circumcision.
There are also simple, non-invasive ways today to reduce even the minor trauma of circumcision.
I have deliberately avoided ad hominem discussion of the motives behind the vitriolic attacks by Schoenfeld and others against infantile circumcision. I leave psychoanalysis to others, although I am not bereft of ideas on the subject.
I also have avoided any discussion of the religious and cultural aspects of a procedure, which has been defended with great sacrifice by generations of Jews who did not submit to the cruel suppression by the Romans several millennia ago or to the no less vicious attack by the Soviets in our lifetime.
That democratic societies in the 21st century should attempt via legal means to outlaw this procedure is a travesty on justice, ethics and humanity. And the contribution of Jews such as Schoenfeld represents an unfortunate tragedy.
The author is a professor emeritus at Ben-Gurion University Faculty of Health Sciences, former dean of the faculty and former ombudsman for Israel National Health Services.