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The circumcision decision: sometimes medicine offers information, not answers

Posted by Dr. Claire McCarthy  March 14, 2012 09:41 AM

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This month the journal Cancer released a study saying that circumcision can help prevent prostate cancer. Men who were circumcised before having sex for the first time had a 12- to 18-percent lower risk of the disease.

Well, that should make it easier for parents to decide about circumcision, right?

Not so much. Because that's because the circumcision decision is another example of how in medicine, information isn't the same as an answer.

There are definitely benefits to having your baby boy circumcised. It can decrease not only the risk of prostate cancer, but also cancer of the penis. It can help prevent urinary tract infections as well as sexually transmitted infections -- in Africa, circumcision has been found to make a big difference when it comes to preventing transmission of HIV from women to men. If you don't have a foreskin, it can't get infected or stuck, and I've seen plenty of cases of both.

But as with any treatment or procedure, there are possible downsides. There's always the risk that something will go wrong and there will be injury or bleeding, although it's not common. It hurts to have skin cut off, although anesthesia can help with that. It's possible that circumcision can interfere with sexual pleasure. And there is the argument that it's not fair to make a permanent decision for an infant.

Which is why when parents ask me if I recommend circumcision, I don't have an answer.

I'm not alone in being on the fence. The American Academy of Pediatrics and the American Urological Association are firmly on the fence with me -- both are very careful not to take a side.

Medicine just isn't as clear as people think it is. I've been doing it for more than 20 years, and I've watched the way we treat everything from asthma to ear infections to heart disease change, sometimes in radical ways. We learn things, we try things out, we study what happens when we try them out. Something that we think is the right answer turns out to be the wrong one. Science isn't exact. It evolves and changes, as new information comes in.

Also, and perhaps more importantly, science doesn't account for everything. The circumcision decision can have everything to do with a person's faith tradition or personal beliefs. It's just one example of how faith and values and family history and real life get mixed into medical decisions.

Medicine works best, I think, when doctors and patients alike understand the difference between information and answers.Then we can make the very best decision -- together.

This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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About MD Mama

Claire McCarthy, M.D., is a pediatrician and Medical Communications Editor at Boston Children's Hospital . An assistant professor of pediatrics at Harvard Medical School and a senior editor for Harvard More »

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