JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, Vol 278 No 3, Page 202.
July 16, 1997.

LETTERS

To the Editor - Circumcision depends upon the perpetuation of American
cultural beliefs that support it.  One way to justify inflicting pain
and harm on others is to believe that otherwise more pain and harm
will follow.  Using this strategy to defend circumcision requires
minimizing or denying the harm caused by circumcision and producing
medical claims about protection from potential future pain and harm.
Circumcision advocates claim that the surgery has prophylactic
benefits.  Laumann et al[1] provide another response to this belief.

   For some people, claims of medical benefits are sufficient
justification for circumcision partly because circumcision is a
surgical procedure that is done on someone else.  Using medical claims
and studies to defend circumcision may be an unconscious way for some
physicians to avoid the emotional discomfort of questioning their own
circumcision.  A survey of primary care physicians showed that circum-
cision was supported more often by physicians were older, male, and
circumcised.[2]

   Full and open debate on the circumcision issue is necessary,
particularly regarding long-term effects and ethical considerations,
but this debate has not yet occurred.  Even with full debate, the
overwhelming pain and harm of circumcision cannot be proven to many
circumcision advocates because people tend to avoid new information
that strongly conflicts with their beliefs.

   Thus far, the feelings of those who must live with the decision -
the infants - generally have been ignored.  The fact that infants
can't physically resist or stop the procedure makes it easy to dismiss
their feelings.  Of course adult feelings are not so easily dismissed.
A preliminary survey of 75 men suggests that the more men know about
the important functions of the prepuce, the more likely they are to be
dissatisfied about being circumcised.[3]  Now that an increasing
number of men are learning about the prepuce and expressing this dis-
satisfaction, clinicians must acknowledge that is impossible to
predict how a male infant will feel when he is older.  A prudent
course of action would be to allow men to make the decision about
circumcision themselves when they reach adulthood.

   What prevents the adoption of such a new policy is the reluctance
to acknowledge such a mistake and all that it implies.  This avoidance
of guilt helps to explain the tenacity with which some people defend
existing circumcision policies,[3] and the ongoing denial requires the
continued acceptance of cultural beliefs.  More than new studies,
clinicians will need courage to change.  The children of the future
are depending on it.

                                     Ronald Goldman, PhD
                                     Circumcision Resource Center
                                     Boston, Mass

1. Laumann EO, Masi CM, Zuckerman EW. Circumcision in the United
   States: prevalence, prophylactic effects, and sexual practices.
   JAMA 1997;277:1052-1057.

2. Stein M. Marx M. Taggert S, et al. Routine neonatal circumcision:
   the gap between contemporary policy and practice. J Fam Prac
   1982;15:47-53.

3. Goldman R. Circumcision-The Hidden Trauma: How an American Cultural
   Practice Affects Infants and Ultimately Us All. Boston, Mass:
   Vanguard Publications: 1997.

Cite as:

Goldman R. Letter. JAMA 1997;278:202.

(Transcribed 16 July 1997)