Fleshing Out Change On Circumcision

Changing its longstanding neutrality on the issue of circumcision, the American Academy of Pediatrics suggested recently that the health benefits of the procedure outweigh its risks. In order to understand the reasoning behind the shift, along with its likely implications, The Jewish Week spoke to Dr. Andrew Freedman, a urologist at the Cedars-Sinai Medical Center in Los Angeles. Freedman was one of the members of the task force that issued the new, qualified endorsement of circumcision.

Q: Why did the AAP decide to alter its stance toward circumcision?

A: We felt, based on a series of recent studies that showed that circumcised men were somewhat less likely to contract HIV, penile cancer and other diseases, that it was time to re-examine our position on the procedure. We also knew that there are modest risks in having the procedure done. On balance, we found that it made sense to recommend that insurance companies begin to cover circumcisions.

If circumcision can help to prevent these diseases, then why not simply recommend that every male child be circumcised?

Circumcision only helps in certain cases. For example, in terms of HIV transmission, it only helps if an HIV negative man is having vaginal intercourse with an HIV positive woman. That’s because an intact prepuce has Langerhans cells that are a target of the HIV virus — the uncircumcised penis has a moister, softer, thinner skin that is more prone to trauma than the skin of a circumcised penis, which is tougher and drier. Still, it might take 2,000 circumcisions to prevent one case of HIV transmission, with a complication rate of one in 500 circumcisions. It’s hard to measure the risks and benefits, but we can say that both appear to be quite modest.

So you’re not actually advocating circumcision?

No, we’re not. Circumcision cuts across cultural, religious, medical and aesthetic lines. We don’t see ourselves as partisan in the battle over circumcision. It might be better to be a vegetarian, or to double-knot your shoelaces, but it’s not for us to tell people what’s in the best interest of their children. The benefits aren’t enough to justify it if it doesn’t fit with the values of a particular family.

Why is there such negative sentiment against circumcision?

I can’t really say. However, I can tell you that I’ve received thousands of e-mails over the years from parents telling me that circumcision is a terrible thing to do to a child, because of what they see as an overriding ethical principle of maintaining bodily integrity until the age of consent. This is where there’s such a big divide between America and Europe; it’s much more accepted here, whereas in Europe there is no tradition, outside of the two religious minorities [Jews and Muslims], of circumcision.

Did the task force examine the question of metzitzah b’peh, or oral suction?

We had a lot of discussion about whether or not to incorporate that into our recommendations, but in the end decided not to, since there are so few that are done that way in this country, and they will continue to be done that way whether or not we recommend against it. I do work occasionally with an Orthodox mohel who uses a tube so that there is no oral-genital contact.

Do you think that the new policy will lead to an increase in the number of circumcisions performed in the U.S.?

I doubt it. There’s definitely been a sea change in people’s attitudes. Circumcisions have declined from 1965, which was the peak, when 85 percent of boys were circumcised, to about 55 percent today. The circumcision rate will probably continue to dwindle. [Those against it] have had an influence in making people think twice about circumcision.

Do you have a son and, if so, did you have him circumcised?

Yes, I do. I circumcised him myself on my parents’ kitchen table on the eighth day of his life. But I did it for religious, not medical reasons. I did it because I had 3,000 years of ancestors looking over my shoulder.

This is an edited transcript.