Jewish News - September, 1990

Circumcision: New Information Raises Questions

By Ronald Goldman

Though many divine laws, rituals, and traditions are ignored by numerous American Jews, such as observing Shabbat and Kashrut, many Jews have accepted circumcision without subjecting it to any intellectual or emotional scrutiny.

There have been several reasons. Many Jewish parents  have not considered circumcision a choice at all. It was expected and not seriously questioned. There was little awareness or knowledge of its effect on the infant. Some parents have had doubts, but they were buried under the avalanche of thoughts related to tradition, history, and fears and insecurities about nonconformance to group practice. Health beliefs may have also played a role.

Recent medical reports have now caused concern and provoked questions by some Jews about this ancient practice. In the March, 1988 issue of the Journal of the American Medical Association, Howard J. Stang, M.D. and colleagues at Group Health Inc. and the University of Minnesota report, "There is no doubt that circumcisions are painful for the baby. Indeed, circumcision has become a model for the analysis of pain and stress responses in the newborn. Not only does the unanesthetized newborn cry vigorously, tremble, and in some cases become mildly cyanotic because of prolonged crying, but other stress-related physiological reactions have also been demonstrated, including dramatic changes in heart and respiratory rates and in transcutaneous oxygen and plasma cortisol levels."

In the November 19, 1987 issue of New England Journal of Medicine, Anand and Hickey, in a comprehensive review of recent medical literature on newborn pain, conclude that newborn responses to pain are "similar to but greater than those in adult subjects." Concerning the memory of pain in neonates they write, "The persistence of specific behavioral changes after circumcision in neonates implies the presence of memory. In the short term, these behavioral changes may disrupt the adaptation of newborn infants to their postnatal environment, the development of parent-infant bonding, and feeding schedules. In the long term, painful experiences in neonates could possibly lead to psychological sequelae, since several workers have shown that newborns may have a much greater capacity for memory than was previously thought."

Dr. Richard Schwartzman of Philadelphia and Dr. Charles Konia of Easton, PA help patients resolve past traumas. Dr. Schwartzman reports, "I have had patients who have re-lived the experience as evidenced by the severe pain felt at the site where the foreskin was cut." Dr. Konia reports, "I can tell you that from my clinical experience in treating patients who relived their circumcision as well as observing newborns being circumcised in the delivery room it is a nightmarish experience. I shudder each time I witness patients going through the horror (emphasis by Dr. Konia)."

Dr. Thomas Verney has conducted more than twenty years of medical research on prenatal experience. In his book The Secret Life of the Unborn Child, Dr. Verney writes that the unborn child is aware and leads an active emotional life from about the sixth month on. "The fetus can see, hear, experience, taste and, on a primitive level, even learn in utero. Most importantly, he can feel... What a child feels and perceives begins shaping his attitudes and expectations about himself." Dr. Verney concludes that parents can actively "help shape the personality of their unborn child. They can actively contribute to his happiness and well-being, and not just in utero, nor in the years immediately following birth, but for the rest of his life (emphasis by Dr. Verney).

Frederick Leboyer has delivered more than 10,000 babies. In Birth Without Violence he writes "People say - and believe - that a newborn baby feels nothing. He feels everything. Everything - utterly, without choice or filter or discrimination." Dr. Leboyer found that babies born with minimal trauma developed into happier and emotionally healthier children. Other studies have shown that babies who are touched develop more quickly and gain more weight.

The new evidence supports the conclusion that the infant's experience in the womb, birth itself, circumcision, and contact after birth have a significant impact on future well-being and functioning.

Jewish circumcision has nothing to do with health factors. However, some people believe it has health benefits. In the past routine hospital circumcision has been promoted as a preventive cure for masturbation, mental illness, venereal disease, cancer, and uncleanliness. Recent studies have disproved all of these claims. Edward Wallerstein's book Circumcision: An American Health Fallacy addresses this issue in convincing detail. The incidence of health problems related to the foreskin is so low that removing it as a preventive cure would be tantamount to performing routine appendectomies to prevent appendicitis. The American Academy of Pediatrics and the American College of Obstetrics have concluded "there are no valid medical indications for circumcisions in the neonatal period."

Some Jews believe, without any specific knowledge, that circumcision methods of mohelim are superior to those of doctors and cause less pain to the infant. Actually, traditional mohel methods such as using sharp fingernails for cutting and sucking blood from the cut by mouth have been abandoned in favor of modern clamp devices. Most mohelim get their training in hospitals and many are also doctors. Orthodox mohelim do not use the clamp devices because they believe bleeding is a religious requirement. Consequently, infants circumcised without clamp devices have more risk of hemorrhaging. In any case, there is no reason to believe that circumcisions by mohelim are less painful to the infant.

Whether an infant is circumcised in the hospital by medical staff or in the home by a mohel, there are medical risks as with any surgery. Though the incidence is very small, there is potential for hemorrhage, infection, and surgical injury. On rare occasions death has resulted. For this reason Jewish law allows for exemptions when other children in the family have died from the effects of circumcision.

There is considerable misunderstanding of the anatomy of the foreskin. Little information has been available about foreskin for laymen or medical professionals. The assumption that it had no useful purpose and could be cut off as inconsequentially as hair is false. Foreskin contains erogenous tissue with a high concentration of sensitive nerves, and it serves an important purpose in intercourse. During erection the foreskin shifts to cover the upper shaft of the penis, a location which would contact the vaginal wall during intercourse. Foreskin also has the purpose of protecting the penis against irritation and is not normally retractable until two or three years after birth.

Without this protection, the penis loses some of its sensitivity. A rare adult who had a circumcision (while under general anesthesia) reported later that the head of his penis "lost its sensitivity and as it did I realized I had lost something rather vital. Stimuli that had previously aroused ecstasy had relatively little effect...Circumcision destroys a very joyful aspect of the human experience for both males and females."

Some who have witnessed circumcisions report little or no crying response from the infant. There are three explanations for this. Nobody wants to hurt infants. Anyone involved in circumcision does not want to believe that it is painful to the infant. Otherwise, he would have to question his support for the practice. Circumcision has been such a fixture in American Jewish culture that questioning it can be very difficult. For many people it is easier to resolve this potential conflict by denying the reality of infant pain.

Rosemary Romberg, author of Circumcision - The Painful Dilemma regrets having her three sons circumcised. The third son, unlike the other two, was born at home into a gentle, loving environment in a Leboyer-type birth. She reports a "profound and dramatic difference in the nature of the baby born in this manner, compared to the baby born by conventional techniques...The baby born to conventional birthing procedures is in a state of trauma anyway - whether he is circumcised or not!! This explains why some babies do not cry or appear to react when their foreskins are clamped and sliced off. The baby is already in a state of withdrawal, simply from other common traumatic procedures associated with conventional birth...Another explanation for the absence of crying during circumcision is that for some babies the shock of the assault is so intense that they cannot cry!" (All emphases are by Romberg.) Rather than endure the experience of overwhelming trauma and pain, the infant may escape into withdrawal or a semicoma state. As adults we also have escape mechanisms for traumatic overload, such as fainting. Therefore, vocal response alone is not always a reliable pain indicator.

Jews have always been supportive of human rights. Human rights must certainly include a right to one's own body. Some Jews are now asking if anyone has the right to represent infants in such a critical irreversible decision as removing a normal, functioning part of their anatomy for religious reasons.

Many Jews associate circumcision with their Jewish identity. However, being circumcised does not make one Jewish. More than one million infants are circumcised in this country every year and the overwhelming majority are not Jewish. Of course, females are not circumcised and some are Jewish. Any child born of a Jewish mother is a Jew, whether circumcised or not.

Since circumcision remains the most commonly practiced American Jewish ritual, choosing not to participate may raise fears about acceptance by other Jews. For some this fear may become the sole or primary justification for circumcising their son. This fear may be highly overrated. Reports from American Jewish uncircumcised males indicate that it has not been an issue for them, their friends, or parents. In Europe, where there is no routine hospital circumcision, many Jews do not circumcise their sons.

In addition to ignorance of previously discussed medical issues, Jews may have engaged in an unintentional silent conspiracy. Those that have been afraid to question or even talk about circumcision have created the illusion that they are alone, when in fact, many share their concerns and are also afraid to express themselves. For many Jews the pressure to conform to tradition may have prevailed over their experience and gut feelings.

Maimonides wrote in The Guide for the Perplexed, “No one, however, should circumcise himself or his son for any other reason but pure faith.” If parents are not aware of the religious purpose of circumcision or do not believe it is a divine requirement, then the decision to circumcise becomes an emotional one instead of a religious one. This seems to be the case for secular Jews as well as many observant Jews.

The decision to circumcise need not be an automatic one. The effects on the infant have been shown to be serious and significant. Not only is his foreskin amputated but a part of his spirit and capacity for pleasure as well. By the time parents hear his painful cries and notice the feeling in their guts it is too late. Before they get to that point it is important for Jews to carefully consider what they would do if they were to have a son and why.

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