The deepest cut
There are numerous inaccurate claims in the article "Prime cut" [November 5]. Let me comment only on your statements that male circumcision may be "mutilating" infant boys, and allegedly has no health benefits.

Curious about the recent appearance of so many newspaper and magazine articles that denigrate circumcision, I have found in my own limited investigation that almost all of these articles were published at the instigation of anti-circumcision organizations such as NOCIRC and NOHARMM. In many recent articles, these groups were the only source of information on the alleged harm from circumcision. Some of their information is completely wrong: For example, they incorrectly claim that urinary tract infections are more prevalent in circumcised boys than non-circumcised, while the exact opposite is true! When there is disagreement about a medical procedure, the proper way to settle the matter is by means of unbiased examination of the facts. Most responsible medical authorities today are neutral or positive in recommending circumcision. Ultimately, the conflicting claims of opposing sides will be sorted out, and the biased and invalid information will be set aside.

These anti-circumcision organizations, which share many of the same individuals on their list of officers, are also active in flooding the Internet with material presenting only one side of the story.

There is at least one Internet source that is more balanced, medically accurate, and complete. Dr. Brian Morris [http://www.physiol.usyd.edu.au/brianm/circumcision.html] is an Australian biologist who has no religious or other motives (he is not Jewish, for example) and presents a very complete and timely bibliography of peer-reviewed professional medical journal studies and published articles. Review of such authoritative material will show you why several of the statements in your article are not accurate:

1. You give the impression that circumcision has no benefits and reduces sexual sensitivity in the adult man. You quote negative conclusions of a study published in the 1997 Journal of the American Medical Association (JAMA) as though it is the official view of the medical profession or the AMA.

First, many articles have been published in JAMA on both sides of this issue. None of these represents the official position of the American Medical Association on the subject. The American Academy of Pediatrics and the Canadian Pediatric Society both have an officially neutral position on circumcision at the present time, but they have changed their official position from endorsing to remaining neutral regarding circumcision several times in past decades. Much medical evidence suggests overall benefits from male circumcision, including the lower UTI rate already mentioned, a lower occurrence of cancer of the uterus in the wives of circumcised men, a reported zero incidence of penile cancer (for males circumcised in infancy), and significantly lower incidence of various infections and abnormalities of the penis.

Second, the most significant number and type of penile nerve endings are in the glans and the frenum, which are not removed or significantly affected by male circumcision. Numerous reports, including several studies of men who were circumcised in their adult years and thus could compare sexual sensitivity before and after, indicate that circumcision either has no change or actually increases the sexual sensitivity of the male. This is attributed to the direct exposure of the glans to frictional contact rather than being covered by the foreskin.

The quotations from the 11th-century philosopher Moses Maimonides regarding this topic illustrate the 11th-century misunderstanding of physiology and anatomy, regardless of Maimonides' fame as a philosopher. Similarly, the incorrect beliefs of several 19th-century doctors who promoted circumcision in the false view that it would reduce masturbation are an amusing historical curiosity, but not a valid reason to abandon circumcision today.

2. Your article implicitly confuses male circumcision (removal of the foreskin) with female genital mutilation (FGM). FGM, as it is practiced in much of Africa, the Middle East, and southwest Asia today, is vastly different from male circumcision and should never be described by the word circumcision. FGM involves the intentional removal of all of the clitoris and the inner labia, for the expressed purpose of destroying all sexual sensitivity. In contrast, many physiologists state that the anatomically accurate analogous procedure to male circumcision, for a female, is the removal of the hymen membrane. Such removal of the hymen causes no significant change in sexual sensitivity, and occurs in the normal course of events for most sexually active females.

3. You refer to a few Jewish people who oppose circumcision, and try to give the impression that there are rumblings of dissent to circumcision. These same few Jewish people are repeatedly trotted out by NOCIRC et al. They do not indicate any growth of Jewish dissent regarding circumcision. In fact, all branches of Judaism strongly require circumcision of infant boys.

4. Pain is the main objection of NOCIRC and other circumcision opponents. While no one claims that circumcision is free of pain unless an anesthetic is used, the claims of NOCIRC and some others that it is the worst level of pain known to mankind are highly questionable. You cite some rather controversial studies. In fact, there is no scientific agreement on a standard way to measure pain, particularly in infants. Let me try to briefly summarize a complex topic on which many, many acrimonious and highly emotional statements have already been made: There are numerous contradictory results in the literature to your cited reports, indicating that the pain of circumcision is relatively small and temporary. More depends on the method of circumcision and the use of anesthetics and other factors.

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