What Your Doctor May Not Tell You About Circumcision:
Untold Facts on America’s Most Widely Performed – and Most Unnecessary – Surgery

Authors: Paul M. Fleiss, M.D., and Frederick M. Hodges, D.Phil.

What Your Doctor May Not Tell You About Circumcision: Untold Facts on America’s Most Widely Performed—and Most Unnecessary—Surgery. By Paul M. Fleiss, M.D., and Frederick M. Hodges, D.Phil. New York City: Warner Books, 2002. 300 pages. US $22.95. www.twbookmark.com. Review by J. Steven Svoboda.

Pediatrician Paul Fleiss and academic Frederick Hodges are perhaps the most prominent and respected authorities regarding circumcision in their respective fields: pediatrics and the history of medicine. They joined forces to create an all-star team and write the first mass-market book about circumcision put out by a major publisher and aimed at ordinary parents considering what to do about North America’s most pervasive and unnecessary form of genital surgery: male circumcision. (Fair disclosure: ARC is referenced twice in the resource appendices at the end of the book.)

Paul and Frederick faced a thorny set of conflicts in writing What Your Doctor May Not Tell You About Circumcision. They presumably wanted to get as much pertinent information to the reader in as accessible a format as possible and to present it objectively, respecting the reader’s own background and history around this issue. They wished to grapple with the peculiar set of myths and disconnects which has managed to perpetuate a harmful practice that has been widely denounced as unnecessary by numerous national and international medical and legal societies. And they wanted to do all this while writing an engaging, accessible book that would keep readers turning the pages. Yet more and more physicians, medical societies, and lawmaking bodies around the United States and around the world are coming to realize that the issue is not a balanced one subject to equally rational positions on both sides. Circumcision is a dumb and even cruel idea we should have dropped many decades ago, pure and simple.

Given these inevitable constraints, the authors did virtually as superlative a job at this complex balancing task as is humanly possible. Necessarily, in order to provide detailed information about the different techniques, or to debunk all leading myths about circumcision’s benefits, the book sometimes veers a bit toward overemphasizing thoroughness. At other times, occasional inaccuracies creep in when the writers employ simpler phraseology which is almost, but not quite, correct.

For example, while they would be right if they wrote that all national and international medical societies that have spoken to the issue have found routine neonatal circumcision unnecessary, their formulation without this modifying phrase fails to account for the California Medical Association’s endorsement of the procedure. Paul and Frederick thereby missed an opportunity to tell a potentially interesting and certainly bizarre story about how a couple zealous circumcisers [themselves circumcised men] induced this state’s medical society to support the practice back in the late eighties. I believe they are off the mark in their suggestion that David Reimer, a Canadian boy who lost his penis in a circumcision and was raised as a girl, filed a lawsuit against the doctors responsible for the harm he sustained. Finally, while the American Academy of Pediatrics’ contradictory, mealy-mouthed 1999 policy statement does state at one point that the “potential benefits” do not support a recommendation for routine circumcision, this is not quite the same thing as the authors’ suggestion that the AAP “actually recommends protecting babies from circumcision in the first place.”

But these are the only nits I could find to pick in Paul and Frederick’s comprehensive, engaging, and carefully documented presentation of all critical issues of concern to parents considering whether or not to cut. The chapter headings read like a what’s what of all matters foreskin-related: What is the foreskin? What happens to a baby during a circumcision? What are the proven complications and risks of circumcision? What about circumcision in religion? What is the history of the procedure? Does it have medical benefits? (The short answer, admirably phrased, is there are a couple alleged benefits that are — barely — statistically significant (because amputation of any body part removes the possibility that that body part may become diseased) but none that are clinically significant in providing any medical justification for the amputative procedure.) What are the common non-medical excuses for circumcision? How should you care for your son’s intact penis? To their credit, the authors also include a chapter on care of the circumcised penis, just in case their advice comes too late or falls on ears made of stone.

The appendices are excellent, including copious source notes and a thorough index along with summaries of medical societies’ position statements and lists of resources and organizations and recommended reading. I personally learned a number of useful and interesting facts from this book, as I am sure any reader would. But despite the undeniable value of collecting all this information in one place in reader-friendly form, perhaps the greatest value of this book is its simple language and deft demystification of one of our culture’s most bizarre and barbaric practices.