By Ronnie Dubrowin CNM, MS, IBCLC
In 1989, when I underwent extensive training to become a certified midwife, the primary focus was women’s health and neonatal health. Back then, men’s health was rarely a consideration. When I was invited to learn about the procedure involved in newborn male circumcision, I was very torn. Some of what I read emphasized an urgent support regarding the benefits of circumcision to men’s health. Other discussions, which rarely referred to medical research, focused on the negative aspects of circumcision.
I ended up mastering the newborn circumcision procedure, as many of the parents whose babies I assisted in delivering requested it. It led me to expand my expertise to include out-of-hospital circumcisions, initially to comply with my patients’ requests for brit milah (the Jewish covenant of circumcision). I then began to accommodate other clients of other faiths who also practiced newborn male circumcision as part of their traditions. Ultimately, I broadened my practice to include babies born outside of hospital settings, as well as those born in hospitals where parents wanted out-of-hospital circumcision.
Over the years, published studies showed clear benefits of male circumcision to both men’s and women’s health. This was confirmed for me while working in a clinic setting where I regularly saw adult men with a certain set of health issues due to not having been circumcised as an infant. What I observed first-hand, combined with evidence-based research, validated the benefits of circumcision.
In 2012, the American Academy of Pediatricians Circumcision Task Force published a statement confirming that the benefits of male newborn circumcision outweighed the risks. Members of the task force included urologists, family practice providers, anesthesiologists, infectious disease specialists, neonatologists, midwives, ethicists, financial analysts, and public health specialists. The experts concluded that circumcision prevents urinary tract infections, decreases HIV spread, decreases HPV spread of all genital types, and reduces spread of syphilis and herpes. Penile cancer rates were lower in circumcised men, as were rates of cervical cancer in their partners.
The literature supports the above evidence, as does my own experience as a practicing midwife. I have seen uncircumcised grown men endure agonizing pain due to balanitis (an infection of the glans of the penis). I have treated genital warts in both circumcised and uncircumcised men, but saw worse warts in uncircumcised men and their partners. Another common and very uncomfortable problem, bacterial vaginosis, is a problem I have encountered with greater frequency in female partners of uncircumcised men.
When I am asked for my views on male circumcision by expectant parents, I always tell them that it is a personal choice, that once done, cannot be undone. There are pros and cons to any procedure, and circumcision is no exception. I always support my patients in whatever choices they make. I also always follow the American Academy of Pediatrics guidelines regarding counseling and circumcision, including all options for pain relief. I am always happy to answer any questions that arise for parents struggling to make this decision.
Ronnie Dubrowin CNM, MS, IBCLC is a certified mohelet with more than 25 years of experience. Contact her at 518-281-3238, or at ronmidwife@gmail.com.
