To think that the American medical community is biased for circumcision is an understatement. The most information that American medical texts provide about the foreskin is that it is removed by circumcision. That would be like describing the female breasts as the part removed by mastectomy, with no regard to function, form, and benefits of having it.
Today we received a couple of images from a book called “Fundamentals of Anatomy and Physiology“, by Dr. Frederic Martini, Dr. Judi Nath and Ed Bartholomew. On their text, the prepuce is described as a “fold of skin” with glands that “secrete a waxy material known as smegma” which “can be an excellent nutrient source for bacteria“. Because of that, “mild inflammation and infections in this area are common, especially if the area is not washed thoroughly and frequently“, but thank God for the solution, because “one way to avoid such problems is circumcision, the surgical removal of the prepuce“.
Then we are told that “in Western societies (especially the United States) this procedure is generally performed shortly after birth” and then we are told that circumcision reduces the risks of UTIs, HIV infection and penile cancer. Finally we are told that the practice remains controversial because of the risks of “bleeding, infections, and other complications“.
Nothing else is said about the foreskin. Not a thought of describing the outer skin, the inner mucosa, the frenulum, the frenular band, the frenular delta, the dartos fascia, the meissners corpuscles, the balanopreputial synechiae, the normal development of retraction, the immunological functions of the foreskin, the gliding motion… you know, the real anatomy and physiology of the foreskin!
So, let’s see. First, they focus their description on the fact that the foreskin secretes smegma. Big deal. Secreting smegma is normal, men and women do it. Smegma can accumulate inside the foreskin of children, and that is normal. Irritations can occur, but irritations can occur on any part of the body; foreskin irritation is often the result of overzealous cleaning or leaving soap residue, or using antibacterial or scented soap, not just from having some smegma.
Removing the foreskin to eliminate smegma is really absurd. Your body will still shed cells, they just won’t accumulate, they will stick to your underwear instead. But even if this was such an important factor, it should be a personal decision, not a parental one.
We are told that Western societies, especially the United States, practice infant circumcision. In fact, it would ONLY be the United States, which hardly accounts for the totality of “Western societies“. Most of the world does not circumcise, not Europe, not Latin America, not non-Muslim Asia. In general, circumcision is limited to the United States, Israel, Philippines, South Korea, Muslim societies and some African tribes. But perhaps mentioning this wouldn’t really make such a good case as the fictitious “Western societies” described by these doctors.
Discussing the topics of UTIs, HIV and penile cancer would take pages and has been done already, here and in other places. Penile cancer, scary as it sounds, is rare, and is mostly associated with HPV infection and maybe with phimosis during adulthood, but it’s not an argument in favor of infant circumcision.
According to a letter to the AAP sent by 38 physicians heads of medical organizations from the actual “Western societies”, “only 1 of the arguments put forward by the American Academy of Pediatrics has some theoretical relevance in relation to infant male circumcision; namely, the possible protection against urinary tract infections in infant boys, which can easily be treated with antibiotics without tissue loss. The other claimed health benefits, including protection against HIV/AIDS, genital herpes, genital warts, and penile cancer, are questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for surgery before boys are old enough to decide for themselves“.
Finally the practice of circumcision is not controversial because of the risk of pain, infection and complications. Yes, those things are problematic, but the practice is controversial because it overrides informed consent and restricts body ownership, by performing an irreversible non-medically necessary genital alteration on a person who is not yet competent to provide informed consent – but who will one day be competent. But of course, they won’t acknowledge the central human rights issue of the controversy, why would they?
So, for a book that sells new for $231 and which is used to educate medical students, we feel that this piece misleading information is a disservice to generations of medical professionals.