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Brit Mila vs. Hospital Circumcision vs.
                                                     No circumcision
What's real, what's paradigm and where's the shift?


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Recently, I had the pleasure of bringing a very young Jewish male child into our Covenant.  This, in fact, was the first such ceremony for me as a student Rabbi in Cleveland.  As I talked about the various points of circumcision both with the family and with various members of my congregation, I discovered opinions and views that truly surprised me.  Enough so, that I felt compelled to write this article.

I guess I was naïve enough to think that most Jews were familiar with the brit and the differences between the procedures.  To say it simply, most Jews I have talked to had NO IDEA of the real facts.

First, Brit Mila is, in fact, the most humane procedure if one is to do a circumcision at all.  Second, it is my opinion that even medically the potential benefits outweigh the potential negatives.

So, my personal preference for a son would be a Brit Mila  I do not see a kinder or more humane choice. 

If you think that circumcising a son using the standard hospital procedure is more humane, you are uninformed of the procedures involved. And even before we address these issues, let's look at the medical facts about circumcision.  Quoting an article by the American Academy of Pediatrics  (© 2000):

Research studies suggest that there may be some medical benefits to circumcision. These include the following: 
 * A slightly lower risk of urinary tract infections (UTIs). A circumcised infant boy has about a 1 in 1,000 chance of developing a UTI in the first year of life; an uncircumcised infant boy has about a 1 in 100 chance of developing a UTI in the first year of life. 
 * A lower risk of getting cancer of the penis. However, this type of cancer is very rare in both circumcised and uncircumcised males. 
 * A slightly lower risk of getting sexually transmitted diseases (STDs), including HIV, the AIDS virus. 
 * Prevention of foreskin infections. 
 * Prevention of phimosis, a condition in uncircumcised males that makes foreskin retraction impossible. 
 * Easier genital hygiene. 

The following are reasons why parents may choose NOT to have their son circumcised: 
 * Possible risks. As with any surgery, circumcision has some risks. Complications from circumcision are rare and usually minor. They may include bleeding, infection, cutting the foreskin too short or too long, and improper healing. 
 * The belief that the foreskin is necessary to protect the tip of the penis. When removed, the tip of the penis may become irritated and cause the opening of the penis to become too small. This can cause urination problems that may need to be surgically corrected. 
 * The belief that circumcision makes the tip of the penis less sensitive, causing a decrease in sexual pleasure later in life. 
 * Almost all uncircumcised boys can be taught proper hygiene that can lower their chances of getting infections, cancer of the penis, and sexually transmitted diseases. (1) 

So, religious reasons aside, circumcision has medical benefits  it is mainly beliefs (rather than facts) about possible complications that fuel the negative position.

But what about the pain, the baby crying?  Don't I care about that?  Yes, I do.  And the ritual Brit Mila performed by a certified Mohel is the most humane way to minimize this.  Let me outline the two procedures.

First the standard hospital procedure: The baby is taken from the mother, transferred to the operating room where he is strapped in place.  A device is attached to the infant's penis called a  Gomko clamp.  The surgeon may choose between no anesthetic, a local crème or a neural block.  Then, the surgeon cuts away the foreskin and either attaches a Plastibell device or sutures the incision or uses another 'sealing' procedure.  In all, the surgery usually takes 10-12 minutes to perform, all the while the infant is without human comforting and strapped in place.  Sometime later, the child is returned either to his crib or to his mother, depending on the hospital procedures.  The time in the operating room, under the glaring lights, is often 30 minutes or longer.

Now a brit mila: The baby is taken from the mother who usually stays in the same room, or at most, just outside the room.  The boy is then transferred either to the lap of the Sandek (godfather) or a pillow.  The baby is given some wine (sweet general anesthetic) and the Mohel may chose between no other anesthetic, a local crème or a neural block.  Then the Mohel takes the foreskin in a metal shield and cuts very quickly.  He has the same choices at the surgeon for sealing the incision, although there is seldom a need for anything much.  And then the child is returned to the mother to nurse.  In all, the Mohel's surgery usually takes about 10 seconds to perform.  The time away from the mother during a traditional brit mila is about 5-10 minutes.

It is sad that so many American Jews have been led into the idea that our ancient ceremony is barbaric and cruel.  It is NOT.  In fact, it has several features that the doctors are only now coming to recognize as beneficial to the baby's well being.  For example, doctors have noted that babies cry less when they are resting on a soft cushion, such as a pillow (or perhaps a Sandek's lap -- we use either) when they are strapped down (of course, we do not strap down).  Since doctors don't have the option of noticing that a baby would be even more comfortable if it is not even strapped down, I will trust that we can understand this.  Another thing that doctors have documented recently is that babies appear much happier when given something sweet to suck on right before the procedure (ever taste most Kiddush wines?).

So we see that traditional brit mila is, in fact, a very 'advanced' procedure, already encompassing beneficial baby-comforting devices doctors are only now learning.  Not bad for a ritual that is thousands of years old.

And it is not really surprising, either, if you think about it.  Judaism teaches kindness and mercy in all things.  One of the greatest wrongs we can do is to inflict even emotional pain on our neighbors.  The laws of kashrut in slaughtering an animal are most concerned with it experiencing minimal suffering and pain.  We even cover the challah while a blessing is said over the wine so that it is not offended.  Does it make sense that a belief system that cares about the feelings of inanimate objects and the pain and suffering of animals would inflict unnecessary pain on infant children?  Fathers and mothers have never wanted their children to scream in pain -- that aspect hasn't changed over thousands of years.

In fact, most babies cry, not at the cutting, but at being removed from the mother and being placed on their backs and held.  Even a baby who does not experience mila will cry if this is done to it.  However, in the long run, this is the only position in which mila can be done safely and quickly.

I have purposely avoided arguments that are centered on the religious context of brit mila/circumcision until now.  And I certainly won't tell anyone what he or she should or should not do.  But I will mention a few observations about the controversy over circumcision.  There is overwhelmingly much more negative 'stuff' out there than there is either positive or unbiased, especially on the web.  In fact, in the searches I did for background on this subject for this particular article yielded about ten negatives to each positive or unbiased site, although many negative sites actually used positive or neutral sounding titles.  I found myself asking why they felt the need to hide their true position as they tried to attract people to their sites.

I always question motives when I find these tactics used.  Why would someone find it so important to 'trick' people into reading articles where they shade facts into emotional negatives?  And they do exactly that  when you read these sites with factual knowledge, you recognize how they distort facts with emotional images.  Often, they actually include the negatives of abstaining from circumcision into a reason for not doing it.  They must be hoping that they have you so emotional and distressed that you do not notice this little twist.

So I am left with a disturbing question: Why would people want to stop parents from performing this rite by making it sound so barbaric?  And why are we, as Jews, willing to look so unkindly at our own rituals and beliefs?  (this is a topic for another article)

Brit mila is very humane, healthful and brings a young male into a connection with a people who have always cared for the good of all (at least that is what we are taught by that ancient text we call Torah).  Our enemies would like nothing better than for us to see evil in our ancient heritage and abandon it.  Please gather the real facts before you decide not to join your son to the covenant through traditional brit mila.  An informed decision is always better than an emotional one, especially if that emotion is fear or anxiety.  And as always, do not hesitate to discuss these matters with your rabbi.  Also, feel free to interview the potential Mohel to see that you are comfortable with his or her procedures.  It is your son and you have both the right and the obligation to decide on what is best for him at this age.

I will end this article with a quote from the policy statement of the American Academy of Pediatrics:
      Existing scientific evidence demonstrates potential medical benefits of newborn  
      male circumcision; however, these data are not sufficient to recommend routine 
      neonatal circumcision. In circumstances in which there are potential benefits and 
      risks, yet the procedure is not essential to the child's current well-being, parents 
      should determine what is in the best interest of the child. To make an informed 
      choice, parents of all male infants should be given accurate and unbiased 
      information and be provided the opportunity to discuss this decision. If a decision 
      for circumcision is made, procedural analgesia should be provided.  (2)

There are many anti-circumcision sites on the web if one does a search  and very few balanced ones.  Here are one or two balanced sites that I found.

The Great Circumcision Debate with Daniel Halperin, PhD
Daniel Halperin, PhD, an Assistant Professor at the Center for AIDS Prevention Studies and Medical Anthropology Program of the University of California, San Francisco, joined us for a discussion about male circumcision. 
http://www.geocities.com/HotSprings/2754/drdanielhalperin.htm

CIRCUMCISION ONLINE NEWS: CIRCUMCISION INFORMATION EXPLAINED BY DOCTORS, MEDICAL ESTABLISHMENTS AND RESEARCHERS
http://www.geocities.com/HotSprings/2754/

Footnotes:
  1 Circumcision --  What is Circumcision? American Academy of Pediatrics  ©2000  Click HERE

  2 Circumcision Policy Statement : Task Force on Circumcision, Pediatrics Volume 103, Number 3 March 1999, pp 686-693 © Copyright 1999 American Academy of Pediatrics  Click HERE
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