Wednesday, June 6, 2012

Rebuttal of Dr. Carolyn Roy-Bornstein on Infant Circumcision

This is my response to Dr Roy-Bornstein (Dr RB) whom in my opinion mis-represents the data in recommending infant circumcision, my arguments will be in bold-italics.

Dr Roy-Bornstein :
The AAP's recommendations on circumcision are pretty neutral. Despite scientific evidence for a reduced risk of numerous infections and cancers, the Academy's 10-year-old policy claims that "the data are not sufficient to recommend routine neonatal circumcision" and concludes that "parents should determine what is in the best interest of the child."
In the 10 years since that policy statement was published, a growing body of scientific evidence bears out many health benefits of the procedure and many in the scientific community are calling for the AAP to modify its position.  In my opinion this is a mis-representation of the data as there is no conclusive evidence that circumcision is necessary in infancy.
One medical benefit of circumcision that has been known for a long time is the decreased risk of urinary tract infection, especially during the first year of life. While the chance of getting a urinary tract infection is 1 in 1,000 for a circumcised boy, the risk increases to 1 in 100 for uncircumcised males.  UTI's are a clear example of misrepresenting the data.  Dr RB concedes the risks of getting a UTI are 1 in 100 which is a minor risk, UTI's are not an infectious disease, and UTI's are genrally easily treatable, female children have much higher rates of UTI's with no surgery indicated, and convential treatment is a course of anti-biotics, so to recommend surgical amputation of a functional body part is a radical departure from conventional medicine.
The other clear advantage that has been known for some time is the effect of circumcision on the prevention of cancer of the penis. Uncircumcised men carry a three-fold increased risk for this rare disease.  Again Dr RB concedes penile cancer is a vary rare occurance, she omits it occurs in elderly men, and amputation of a functional body part of an infant for a rare disease in an elderly man is not recommended by any medical organisation in the world, and therefore another misrepresentation of the data. 
There are also conditions that only uncircumcised males experience such as paraphimosis, a painful state where the foreskin, once retracted, becomes trapped, unable to be returned to its original position. Balanoposthitis or infection of the glans and foreskin, also only occurs in uncircumcised males.  Usually rare and treat when occurs.
But the last five to 10 years have brought a number of very good studies looking at circumcision and risk of sexually transmitted infections including human immunodeficiency virus (HIV), human papilloma virus (HPV), and herpes simplex virus.
In 2007, two randomized controlled clinical trials — the gold standard for study design — in Kenya and Uganda found that male circumcision decreased male heterosexual HIV acquisition by 50 percent to 60 percent.  This is a total misrepresentation of the data and has nothing to do with infants.   Infants dont have sex, Africa is a continent with high-prevalence HIV, America is not Africa. The research applied to adult men who volunteered and made informed consent decisions, and there is no reason why adult men around the world cannot make the decision for themselves, once they have decided what lifestyle decisions and risks factors they face .  DR RB makes no mention of human rights issues that exist when removing a functional body part from a minor that cannot consent, and may have zero risk of lifetime exposure..

Those numbers may not be directly applicable to males here in the United States, where many HIV infections are acquired through intravenous drug use and men having sex with men. But a US study of patients in an inner city sexually transimitted infections clinic found that HIV rates in uncircumcised males were 22 percent compared with 10 percent in circumcised men. The consistency between this observational study and the African trials suggests this concern may not have legs, and supports the long term protective effect of the practice.  DR RB again misrepresents the data, as she selectively chooses data to argue her point and omits data which contradicts her arguments. Again infants dont have sex.  Advocates for Youth research found the USA had much higher HIV & STI's than Non-Circumcision Europe, and found that behaviour and education differences were the main factors for differences found.  Behaviour is found to be more important than Circumcision status, and WHY the USA has 1200% higher HIV infections than No-Circ Finland, 3300% higher Gonorreah infections, and 1900% higher infections than No-Circ Hilland.

Two other trials showed that male circumcision decreased the rate of herpes infection by about a third.
Circumcision also decreases penile infection with human papilloma virus (HPV), the leading cause of cervical cancer in women and genital warts in both sexes, again by about a third.
Female partners of circumcised males also enjoy some benefits. Bacterial vaginosis and Trichomonas vaginalis infections in these women were reduced by almost half compared with women whose male partners were uncircumcised.  Again & as before, this is selectively biased, and a misrepresentation of the data, and nothing to do with infants who dont have sex. 
The risks of neonatal circumcision are small, less than 1 percent. The most common complications are bleeding and infection. More serious outcomes are extremely rare. Again a selective misrepresentation of the data on circumcision complications. A Systematic review of complications from circumcision in the BMC Urology found the range of complications was  between 0 to 16%, and the range of serious events was between 0 to 2%.  Research found here

Dr RB does not concede the foreskin is a functional male sex organ, minimises human rights issues and that men might actually want a say over their own bodies, and argues that circumcision is required in infancy becuase of the risk of UTI's which is very small 1 in 100, and easily treatable by anti-biotics.
Dr. Carolyn Roy-Bornstein is a board certified pediatrician with Merrimack Valley Child and Adolescent Health and Merrimack Valley Hospital. Her office is at Merrimack Health Center, 62 Brown St. adjacent to the hospital. She can be reached at 978-521-8108. Parents are invited to e-mail questions to


  1. Another quack doctor who has the temerity and arrogance to presume that she knows better than nature which evolved the male penis (as in all mammals) with a foreskin for sound biological reasons. It is a continuing disgrace that irresponsible professionals (sic) such as her are legally allowed to excise perfectly healthy and functional body tissue from powerless infant males. I note that she is proud of her works of fiction. It is a pity that the thin line between fact and fiction is often blurred.

  2. Great rebuttal! I find it so difficult to understand why MEN believe this crappola is not rocket science to understand that nature makes baby boys with a foreskin for good reasons.....and NO ONE should be cutting off a healthy normal part of an infants body...NO ONE!

  3. And no mention of the availability of an HPV vaccine. The Hebrew name 'Bromstein' hints at her true motivation at promoting this harmful and unethical surgery on the sexual organs of minors.