Infant male circumcision continues despite growing questions about its medical justification. As usually performed without analgesia or anaesthetic, circumcision is observably painful. It is likely that genital cutting has physical, sexual and psychological consequences too. Some studies link involuntary male circumcision with a range of negative emotions and even post-traumatic stress disorder (PTSD). Some circumcised men have described their current feelings in the language of violation, torture, mutilation and sexual assault. In view of the acute as well as long-term risks from circumcision and the legal liabilities that might arise, it is timely for health professionals and scientists to re-examine the evidence on this issue and participate in the debate about the advisability of this surgical procedure on unconsenting minors.
The debate about the advisability of circumcision in English-speaking countries has typically focused on the potential health factors. The position statements of committees from national medical organizations are expected to be evidence-based; however, the contentiousness of the ongoing debate suggests that other factors are involved. Various potential factors related to psychology, sociology, religion and culture may also underlie policy decisions. These factors could affect the values and attitudes of medical committee members, the process of evaluating the medical literature and the medical literature itself. Although medical professionals highly value rationality, it can be difficult to conduct a rational and objective evaluation of an emotional and controversial topic such as circumcision. A negotiated compromise between polarized committee factions could introduce additional psychosocial factors. These possibilities are speculative, not conclusive. It is recommended that an open discussion of psychosocial factors take place and that the potential biases of committee members be recognized.Key Words: Circumcision; Evidence-based medicine; Health policy; Peer review La politique relative à la circoncision : Une perspective psychosociale Le débat quant à l'opportunité de la circoncision dans les pays de langue anglaise a généralement été axé sur les facteurs de santé potentiels. On s'attend que les documents de principes des comités d'organisations médicales nationales soient fondés sur des faits probants, mais le caractère litigieux de ce débat laisse supposer la présence d'autres facteurs. Divers facteurs potentiels reliés à la psychologie, à la sociologie, à la religion et à la culture peuvent également être sous-jacents aux décisions de principe. Ces facteurs peuvent influer sur les valeurs et les attitudes des membres des comités médicaux, sur le processus d'évaluation de la documentation médicale et sur la documentation médicale même. Bien que les professionnels de la santé accordent beaucoup d'importance à la rationalité, il peut être difficile de procéder à l'évaluation rationnelle et objective d'un sujet aussi controversé et émotionnel que la circoncision. Un compromis négocié entre les factions polarisées des comités risque d'introduire des facteurs psychosociaux supplémentaires. Ces possibilités sont spéculatives, non concluantes. Il est recommandé de tenir une discussion ouverte sur les facteurs psychosociaux et d'admettre les préjugés potentiels des membres des comités.T he debate about the advisability of nontherapeutic neonatal circumcision in English-speaking countries has typically focused on the potential health factors (eg, prevention of infection and disease). The conflicting opinions and conclusions in the medical literature on circumcision, together with the tenacity with which advocates and critics of circumcision hold on to their viewpoints, suggest that deep, unrecognized or implicit psychosocial factors are involved (1). The existence of these factors may influence decision-making on ...
Although mandated inquiry led to the detection of substantial abuse and trauma, this information was rarely used in assessment and treatment planning. Implementation of mandated inquiry should be accompanied by relevant education and supervision to ensure that clinicians understand the diagnostic and treatment implications of past trauma.
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