To cut or not to cut?

I am a doctor. 

In my opinion, routine neonatal circumcision is unnecessary.

True, it is protective against  recurrent urinary tract infections in male children, helps to reduce infection rates for STIs in adults and helps reduce the incidence of penile cancer. 

None of these conditions is particularly common in the first place, bar any interventions. All of them are also preventable with good perineal hygiene. Yes, a circumcised penis is easier to care for than an uncircumcised one, but even that is relative. 

The decision to go ahead with this is largely based on personal and/ or cultural beliefs.

I do not have any issues with those who choose to do this or those who don’t. I just do not do the procedure myself. 

This Friday I was forced to assist in the circumcision of some infants. I had told my senior resident that I do not participate in the ritual for personal reasons. We argued a little. I cited the instances of other African countries where circumcision while practiced,  was deferred till adolescence- no gaping differences in childhood UTI rates, no differences either in penile cancer rates. In Southern Africa where adult circumcision was studied for its role in STIs, HIV in particular, it hadn’t been compared with neonatal circumcision or use of barrier contraceptives. Most definitely it couldn’t be superior to safe sex in preventing STIs. I tried to get her see that apart from being fixated on the cultural aspect of the practice, there was no consistent, reasonable ad significant benefits of the practice. I did agree that if people wanted circumcision, then the neonatal period would pose less complications. However, how are we to determine that the child would have chosen same for themselves had they had the choice? 

It became an issue of insubordination for her and she gave me a direct instruction to participate in the procedure for that morning. Before long, news had circulated around the small hospital that I didn’t agree to neonatal circumcision and everyone came to see if I would attend the procedures for that morning. 

I did. 

I spoke very little. I let them stew over some of the points I had raised. We do not routinely use anesthesia during the procedures. Everyone else was smiling and making jokes at my expense while the babies’ cries droned on in my ears. 

If only they knew I couldn’t even hear their comments. 

The last procedure we did. It was bloody. We couldn’t get the plastibel device to fit properly, so it had to be done free hand. Was it bloody? Was it painful? The baby just kept yapping on and on. 

I am even scared to think of the cosmetic results of  that one…

Sadly, whatever the results are, no one will complain, no one will sue. Life will go on, as it has always gone on and as it always will go on. 

We here are the doctors of the community. One step in knowledge and ability, only below God.