MEDICAL FRAUD and the criminal assault of boys
An Emphatic Vote Against Circumcision
Leonard J. Marino M.D.
Recent articles citing the increased frequency of urinary tract infections (UTI) in uncircumcised males have revived interest in a procedure that is otherwise medically difficult to justify. If circumcision is recommended to prevent and easily treatable infection, how much more indicated is the clitoral hood removal in females? After all, females suffer UTI six to ten times more than females, and the area in question is far more difficult to cleanse. If circumcision is necessary for cleanliness, why are most circumcisions only partial procedures in which half to three fourths of the foreskin is removed, leaving and allowing smegma to accumulate?
In my private pediatric practice (middle to upper middle class), I see about 150 patients a week. For a one month period this year, I saw twenty two male patients with a genitourinary complaint, twenty of whom were circumcised. In ten patients, the foreskin remnant adhered to the glans, covering the sulcus, so that when released, varying amounts of smegma appeared. Two could not be released and will need surgery to separate the foreskin adhesions.
Five of the twenty circumcised patients has meatitis and urinary frequency, which cleared after treatment with oral sulfa. Two males urinated with difficulty, one of them having two streams, the other three. One of these patients has had surgery (meatotomy) three times; the other is scheduled to have it done.
It is of interest that meatitis requiring surgery, because of the attendant meatal stenosis, is almost exclusively an illness of the circumcised. In twenty five years, non of my uncircumcised patients has needed a meatotomy, compared to an average of three per year in the circumcised group. All of those patients have had four or more of the following symptoms or findings: dysuria, frequency, hematuria, meatitis, meatal stenosis, and urinating in more than one stream.
The recent report of the American Academy of Pediatrics Task Force on Circumcision says there is no evidence that meatitis leads to meatal or urethral stenosis. It seems to me that the relationship of the two is difficult to deny.
It has been my custom for the last fifteen years to do a routine urinalysis in newborns at two months of age. Rarely is any abnormality found. In fifteen years I have admitted only three infants to a hospital with illness of the urinary tract: two girls with hydronephrosis, and a circumcised male with UTI.
Since one fourth of my male infant patients are not circumcised, and the frequency of UTI in the uncircumcised is as high as it is said to be, I should be seeing many UTIs in male infants. If I'm missing the diagnosis, they somehow are getting better without treatment. My experience reinforces the practice of discouraging routine circumcision, a cause of more morbidity than benefit.
Leonard J. Marino M.D.
Plainview, N.Y.
Letter to Contemporary Pediatrics November 1989.