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JewishJournal.com

July 26, 2012

Health issue or anti-Semitism: Switzerland joins German circumcision ban

http://www.jewishjournal.com/opinion/article/health_issue_or_anti-semitism_switzerland_joins_german_circumcision_ban_201

Brit Milah

Brit Milah

Today come reports that hospitals in Zurich and St. Gallen have suspended the practice on Jewish and Muslim boys in the wake of a similar ban in Germany ordered by a judge in Cologne.

Judges in Cologne concluded that circumcision, even when performed by a doctor, is considered “bodily harm,” since a boy under age 14 years cannot legally give consent. And now Berlin’s Jewish Hospital banned this procedure out of fear that its Doctors could face prosecution and even incarceration.  The Netherlands had banned circumcision stating that ‘it was ritual slaughter’, but recently reversed this ruling.

Great Britain’s Orthodox Chief Rabbi said that a ban on circumcision was mandated by two of the Jewish peoples’s worst enemies – the Seleucid ruler Antiochus IV and the Roman Emperor Hadrian.

Believe it or not, an American city, San Francisco, was set to vote to proscribe one of the central rituals of an entire religious community, the Jewish people, who have been circumcising male infants since the time of Abraham.  Fortunately, the vote was postponed.  Many Muslims, of course, also practice circumcision, while millions of other American parents have eagerly supported this procedure for their infants for hygienic or health reasons.  To add fuel to the fire, anyone who performs a circumcision may be fined $1000 or be committed to a year in jail if this vote was affirmative.  Mark Stern, a lawyer for the American Jewish Committee, said, “This is the most direct assault on Jewish religious practice in the United States.  It is unprecedented in Jewish life.”  The proponents of the bill insist that circumcision is “mutilation and barbaric.  Under pressure, the vote did not materialize.

Russell Crowe (the actor) said: “Circumcision is barbaric and stupid.  Who are you to correct nature?”  Is the “You” the Jew?  ” But do not be concerned,” Russell Crowe continues.  “I have many Jewish friends.  I love my Jewish friends.  I love the apples and the honey and the funny little hats, but stop cutting your babies,” he declared.  Who gave him a moral authority that he knows what is best for Jews, Muslims, and others who prefer the benefits of circumcision for their male children.

Anti-circumcision activists have been speaking out against circumcision for decades, but in the last several years the San Diego-based advocacy group has prepared anti-circumcision legislation for 46 states.  The head of the group says that “his circumcision as an infant resulted in diminished sexual sensitivity as an adult.”  Is this double-speak?  How would he know the difference?  Does he know for a fact that his limitations or an inability to have sexual gratification is a result of his circumcision?  Does he conclude that for thousands of years, no Jews or Muslims or billions of other people have had no or limited sexual satisfaction?  There are some data to suggest the opposite – that removal of the foreskin allows greater gratification.   

MEDICAL CONCERNS:

The warm, moist mucosal environment under the foreskin favors growth of microorganisms creating an environment that could lead to infection both to the man himself and his sexual partner(s)

Paraphimosis is a condition in which the skin that normally folds over the penis, the foreskin, tightens and retracts and cannot return to its normal position over the head of the penis.  If not corrected, the penis will swell and the blood flow to the head may be cut off, damaging the tissue.  It is usually caused by inflammation or infection of the foreskin and may be associated with poor personal hygiene.  Paraphimosis can only occur in uncircumcised men.  Treatment includes circumcision on an emergency basis.

Phimosis occurs when the distal foreskin cannot be retracted over the glans penis.  In the infant, the foreskin normally cannot be retracted over the glans and should not be forced.  With normal growth and stretching of the foreskin, it will become retractable in 90% of children by the age of 6 years.  However, local irritation or infection (balanoposthitis) can cause an abnormal constriction of the foreskin, preventing it from retracting normally.  Often there is pain and swelling, which may be associated with infection of the glans.  Occasionally, a urinary tract infection is present.  A circumcision is indicated particularly when there is superimposed balanitis, balanoposthitis, urinary tract infection, or obstruction.

Balanitis and balanoposthitis are infections of the glans and foreskin.  It is most commonly found in uncircumcised males and frequently presents during the preschool years.  Balanitis may be caused by entrapment of organisms under a poorly retractable foreskin—gram-negative or gram-positive bacterial organisms may be causative, and recently, group A beta hemolytic strep has been implicated.  Monilia infections (yeast) are also associated with balanoposthitis in infants.  Syphilis should also be considered. 

Signs and symptoms include swelling, erythema, penile discharge, pain on urination, bleeding, and occasionally ulceration of the glans.  Additionally, a careful examination of the base of the penis should be performed to look for a strand of hair, which may cause strangulation and edema.

Various types of injuries and trauma can involve the foreskin.  One extremely painful example is when the foreskin “gets caught” in the zipper of the boy’s pants, resulting in an extremely painful emergency situation requiring immediate circumcision.

BENEFITS OF CIRCUMCISION

The benefits of circumcision include: (1) decrease in many types of infections (2) decrease in “strangulation” of the penis; (3) lower incidence of inflammation of the head of the penis, (4) reduced urinary tract infections, (5) fewer problems with erections, (6) a decrease in certain sexually transmitted infections, such as HIV, HPV, genital herpes, syphilis, and other microorganisms in men and their partners, (7) almost complete elimination of invasive penile cancer,  (8) a decrease in urological problems generally, and (9) prevention of the foreskin getting “stuck in the zipper.”

An article was published in Lancet on January 6, 2011, written by Maria Wawer, et al. from Johns Hopkins University and Rakai, Uganda.  Male circumcision has been linked to a reduction of HPV infection in men and a reduced risk for cervical neoplasia in women with circumcised partners.  The results showed a significant reduction of 28% in the prevalence of high-risk HPV infection in female partners of circumcised males.  Male circumcision also reduced the incidence of high-risk HPV in women.  The authors suggest the reduced penile HPV carriage may explain the way in which circumcision helps prevent HPV infection in women.  The authors conclude that their findings indicate that male circumcision should now be accepted as an efficacious intervention for reducing the prevalence and incidence of HPV infections in female partners.

Problems involving the penis are not rare in pediatric practice.  A study by Wiswell (1980-1985) looked at 136,000 boys born in U.S. Army hospitals, where 100,000 were circumcised, and there was less than 0.01% complications, which were mostly minor with no deaths.  But of the 36,000 who were not circumcised, the problems were more than ten times higher and there were two deaths (Wiswell and Hachey, 1993).

THE WORLD HEALTH ORGANIZATION

The WHO and several Centers for Disease Control support circumcision as a preventative measure against HIV transmission.

SOCIETAL AND POLITICAL PRESSURE

There are recent alarming reports of harassment by medical professionals of new mothers (especially Jews) in an attempt to stop them from having this procedure carried out.  There has been a trend by pediatric organizations to skirt the truth in favor of what could be viewed as “New Age political correctness,” spurious “human rights” rhetoric, or perhaps fear of litigation stemming from a very, very unlikely surgical mishap.

Is it remotely possible that we are beginning to experience the events of the 1920s and 1930s in Germany – where governmental rules were “codified and classified and recorded to ensure the proper conduct of current and future generations.”?


Dr. Norman Lavin is a clinical professor at UCLA Medical School.

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