HUMAN RIGHTS ADVOCATES RESPOND TO THE AMERICAN ACADEMY OF PEDIATRICS’ DISREGARD FOR ETHICS AND THE HIPPOCRATIC OATH WITH THEIR CIRCUMCISION POLICY STATEMENT RELEASED ON MONDAY AUGUST 27, 2012.
The WHOLE Network, a grassroots organization dedicated to providing accurate information about circumcision, acknowledges the individual’s right to bodily autonomy. Therefore we find that the only acceptable circumcision policy statement would be one that guarantees that right to the patient in the absence of medical necessity. When performed on a non-consenting minor, routine male infant circumcision violates medical ethics and ignores the first principle of the Hippocratic Oath: First, do no harm.
The last policy statement issued by the AAP in 1999 and reaffirmed in 2007 acknowledges that the modest potential benefits of circumcision do not outweigh the risks. The 2012 statement from the AAP asserts that the benefits of infant circumcision outweigh the risks of the procedure, and that all families should be allowed the option of circumcising infant sons. By suggesting the decision is best left in the hands of the parents, the AAP ignores the ethical dilemma of the leaving the patient out of this decision when he is the person who has to live with the irreversible consequences of the procedure.
Citing evidence from three studies in Africa that found a reduced rate of HIV transmission to circumcised males, the AAP has irresponsibly dismissed conflicting evidence that distinctly calls the effectiveness of circumcision on HIV rates into question.[1-4] The AAP also cites a reduction in urinary tract infections, even though the circumcision procedure itself can cause life-threatening infection.[5-7] Reduced risk of penile cancer is touted, but this cancer is so rare a man is more likely to experience breast cancer[8] than cancer of the penis in his lifetime.[9] The AAP fails to acknowledge that easier, less-costly, non-invasive measures exist for all of the supposed benefits of circumcision, such as condoms, antibiotics, and proper hygeine.
Further, the AAP has turned a blind eye to mounting evidence that circumcision is a harmful practice with serious risks such as hemorrhage [10-19], accidental dismemberment,[20-36] and death,[37-46] and potential life-long physical, psychological,[47-57] and sexual consequences ranging from a personality disorder to erectile dysfunction to orgasm difficulties, with sexual side-effects also extending to his partner.[58]
It is important to remember that the task force charged with reviewing and updating the academy’s position on circumcision is not without conflict of interest. The AAP is a professional organization, which exists to represent and support the professional interests of its members. In its last position statement they acknowledged that those members stand to lose an estimated $150-270 million dollars if circumcisions were no longer performed, without including follow-up care and corrective procedures, which are quite common.[59] The new statement proclaims, "Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it, and to warrant third-party payment for circumcision of male newborns," revealing whose interests they truly have in mind.
Last year when the AAP issued a call to allow physicians to offer a ‘ritual nick’ on the genitals of girls,[60] the immediate and intense public response led to a prompt retraction. The WHOLE Network calls upon the AAP to act quickly to retract the 2012 circumcision statement, and instead put the rights and well-being of the patient before all other interests by condemning routine infant circumcision.
For more information, please visit www.wholenetwork.org
The WHOLE Network, a grassroots organization dedicated to providing accurate information about circumcision, acknowledges the individual’s right to bodily autonomy. Therefore we find that the only acceptable circumcision policy statement would be one that guarantees that right to the patient in the absence of medical necessity. When performed on a non-consenting minor, routine male infant circumcision violates medical ethics and ignores the first principle of the Hippocratic Oath: First, do no harm.
The last policy statement issued by the AAP in 1999 and reaffirmed in 2007 acknowledges that the modest potential benefits of circumcision do not outweigh the risks. The 2012 statement from the AAP asserts that the benefits of infant circumcision outweigh the risks of the procedure, and that all families should be allowed the option of circumcising infant sons. By suggesting the decision is best left in the hands of the parents, the AAP ignores the ethical dilemma of the leaving the patient out of this decision when he is the person who has to live with the irreversible consequences of the procedure.
Citing evidence from three studies in Africa that found a reduced rate of HIV transmission to circumcised males, the AAP has irresponsibly dismissed conflicting evidence that distinctly calls the effectiveness of circumcision on HIV rates into question.[1-4] The AAP also cites a reduction in urinary tract infections, even though the circumcision procedure itself can cause life-threatening infection.[5-7] Reduced risk of penile cancer is touted, but this cancer is so rare a man is more likely to experience breast cancer[8] than cancer of the penis in his lifetime.[9] The AAP fails to acknowledge that easier, less-costly, non-invasive measures exist for all of the supposed benefits of circumcision, such as condoms, antibiotics, and proper hygeine.
Further, the AAP has turned a blind eye to mounting evidence that circumcision is a harmful practice with serious risks such as hemorrhage [10-19], accidental dismemberment,[20-36] and death,[37-46] and potential life-long physical, psychological,[47-57] and sexual consequences ranging from a personality disorder to erectile dysfunction to orgasm difficulties, with sexual side-effects also extending to his partner.[58]
It is important to remember that the task force charged with reviewing and updating the academy’s position on circumcision is not without conflict of interest. The AAP is a professional organization, which exists to represent and support the professional interests of its members. In its last position statement they acknowledged that those members stand to lose an estimated $150-270 million dollars if circumcisions were no longer performed, without including follow-up care and corrective procedures, which are quite common.[59] The new statement proclaims, "Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it, and to warrant third-party payment for circumcision of male newborns," revealing whose interests they truly have in mind.
Last year when the AAP issued a call to allow physicians to offer a ‘ritual nick’ on the genitals of girls,[60] the immediate and intense public response led to a prompt retraction. The WHOLE Network calls upon the AAP to act quickly to retract the 2012 circumcision statement, and instead put the rights and well-being of the patient before all other interests by condemning routine infant circumcision.
For more information, please visit www.wholenetwork.org
References
1. Brewer D. Scarification and male circumcision associated with HIV infection in Mozambican children and youth. Webmedcentral 2011;2(9):WMC002206.
2. Darby, R. L., & Van Howe, R. S. (2011). Not a surgical vaccine: there is no case for boosting infant male circumcision to combat heterosexual transmission of HIV in Australia. Australian and New Zealand Journal of Public Health, 35, 459-465.
3. Green, L. et al., "Male Circumcision and HIV Prevention: Insufficient Evidence and Neglected External Validity," American Journal of Preventive Medicine 39 (2010): 479-82.
4. Thomas AG, Bakhireva LN, Brodine SK, Shaffer RA Prevalence of male circumcision and its association with HIV and sexually transmitted infections in a U.S. navy population. Abstract no. TuPeC4861. Presented at the XV International AIDS Conference, Bangkok, Thailand, July 11-16, 2004.
5. Bliss Jr DP. Healey PJ, Waldhausen JHT. Necrotizing fasciitis after Plastibell circumcision. J Pediatrics 1997;31:459-62.
6. Cook J, Parish JA, Shooter RA: Acquisition of Staphylococcus aureus by newborn babies in a hospital maternity department. Br Med J 1938;1:74-8.
7. Hurst V. Transmission of hospital staphylococci among newborn infants. Pediatrics 1960;25:204-14.
8. "What Are the Key Statistics about Breast Cancer in Men?" What Are the Key Statistics about Breast Cancer in Men? N.p., n.d. Web. 23 Aug. 2012. <http://www.cancer.org/Cancer/BreastCancerinMen/DetailedGuide/breast-cancer-in-men-key-statistics>.
9. "What Are the Key Statistics about Penile Cancer?" What Are the Key Statistics about Penile Cancer? N.p., n.d. Web. 23 Aug. 2012. <http://www.cancer.org/Cancer/PenileCancer/DetailedGuide/penile-cancer-key-statistics>.
10. Shulman J, Ben-hur N, Neuman Z. Surgical complications of circumcision. Am J Dis Child 1964; 107:149-54.
11. Patel H. The problem of routine infant circumcision. Can. Med. Assoc. J 95 (Sept 10, 1966): 576-581.
12. Gee WF, Ansell, NF. Neonatal circumcision: a ten year overview; with comparison of the Gomco clamp and the Plastibell device. Pediatrics 1976; 58: 824-7.
13. Kaplan GW. Complications of circumcision. Urol Clin N Amer 1983;10:543-549.
14. Griffiths DM. Atwell JD. Freeman NV. A prospective survey of the indications and morbidity of circumcision in children. European Urology 1985 11(3):184-7.
15. Williams N, Kapila L. Complications of circumcision. Br J Surg 1993; 80:1231-36.
16. Killick CJ, Barton CJ, Aslam S, Standen GR. Prenatal diagnosis in factor XIII-A deficiency. Arch Dis Child Fetal Neonatal Ed 1999;80:F238-F239.
17. Hiss J, Horowitz A, Kahana T. Fatal haemorrhage following male ritual circumcision. J Clin Forensic Med 2000;7:32-4.
18. Corbett HJ, Humphrey GME. Early complications of circumcisions performed in the community. Br J Gen Pract 2003;53(496):887-8.
19. Newell TEC. Judgement of inquiry into the death of McWillis, Ryleigh Roman Bryan. Burnaby, B.C.: British Columbia Coroner's Service, Monday, 19 January 2004.
20. Brimhall JB. Amputation of the penis following a unique method of preventing hemorrhage after circumcision. St Paul Med J 1902; 4: 490
21. Lerner BL. Amputation of the penis as a complication of circumcision. Med Rec Ann 1952;46:229-31.
22. Levitt SB, Smith RB, Ship AG. Iatrogenic microphallus secondary to circumcision. Urology 1976; 8: 472-4.
23. Izzidien AY. Successful replantation of a traumatically amputated penis in a neonate. Journal of Pediatric Surgery April 1981,16(2):202-203.
24. Hanash KA. Plastic reconstruction of partially amputated penis at circumcision. Urology 1981; 18(3): 291-3.
25. Azmy A, Boddy SA, Ransley PG. Successful reconstruction following circumcision with diathermy. Br J Urol 1985; 57: 587-8.
26. Yilmaz AF, Sarikaya S, Yildiz S, et al. Rare complication of circumcision: penile amputation and reattachment. European Urology (Basel) 1993; 23(3): 423-424.
27. Audry G, Buis J, Vazquez MP, Gruner M. Amputation of penis after circumcision--penoplasty using expandable prosthesis. Eur J Pediatr Surg 1994; 4: 44-5.
28. Hanukoglu A, Danielli L, Katzir Z, Gorenstein A, Fried D. Serious complications of routine ritual circumcision in a neonate: hydro ureteronephrosis, amputation of glans penis, and hyponatraemia. Eur J Pediatr 1995; 154: 314-5.
29. Gluckman GR et al. Newborn Penile Glans Amputation During Circumcision and Successful Reattachment. Journal of Urology (Baltimore), vol. 153 no. 3 Part 1 March 1995 pp. 778-779.
30. Strimling BS. Partial amputation of glans penis during Mogen clamp circumcision. Pediatrics 1996; 97: 906-7.
31. Neulander E, Walfisch S. Kaneti J. Amputation of distal penile glans during neonatal ritual circumcision -- a rare complication. Br J Urol 1996; 77: 924-5.
32. Sherman J, Borer JG, Horowitz M, Glassberg KI. Circumcision: successful glanular reconstruction and survival following amputation. J Urol 1996; 156: 842.
33. Van Howe RS. Re: circumcision: successful glanular reconstruction and survival following traumatic amputation (Letter). J Urol. 1997;158:550.
34. Coskunfirat OK, Sayiklkan S, Velidedeoglu H.. Glans and penile skin amputation as a complication of circumcision (letter). Ann Plast Surg 1999;43(4):457.
35. Siegel-Itzkovich J. Baby's penis reattached after botched circumcision. BMJ 2000;321:529.
36. Park JK, Min JK, Kim HJ. Reimplantation of an amputated penis in prepubertal boys. J Urol 2001;165:586-7.
37. Holt LE. Tuberculosis acquired through ritual circumcision. JAMA 1913;LXI(2):99-102.
38. Reuben MS. Tuberculosis from ritual circumcision. Proceedings of the New York Academy of Medicine 1916; (December 15): 333-334.
39. Rosenstein JL. Wound diphtheria in the newborn infant following circumcision. J Pediatr 1941;18:657-8.
40. Gairdner D. The fate of the foreskin. A study of circumcision. BMJ 1949; 2: 1433-37.
41. Scurlock JM, Pemberton PJ. Neonatal meningitis and circumcision. Med J Aust 1977;1:332-334.
42. Cleary TG, Kohl S. Overwhelming infection with group B beta-hemolytic streptococcus associated with circumcision. Pediatrics, Vol 64, no 3, (September 1979), pp. 301-303.
43. Hiss J., Horowitz A., Kahana T. Fatal haemorrhage following male ritual circumcision. J Clin Forensic Med 2000;7:32-4.
44. Newell TEC. Judgement of inquiry into the death of McWillis, Ryleigh Roman Bryan. Burnaby, B.C.: British Columbia Coroner's Service, Monday, 19 January 2004.
45. Paediatric Death Review Committee: Office of the Chief Coroner of Ontario. Circumcision: a minor procedure? Paediatr Child Health 2007;12(4):311-2
47. Bollinger, D. and Van Howe, R. , "Alexithymia and Circumcision Trauma: A Preliminary Investigation," International Journal of Men's Health (2011); 184-195.
48.Glover E. The ‘screening’ function of traumatic memories. Int J Psychoanal 1929; 10:90-93.
49. Cansever G. Psychological effects of circumcision. Br J Med Psychol 1965; 38: 321-31.
50. Flaherty, JA. Circumcision and Schizophrenia. J Clin Psychiatry 1980; 41: 96-98.
51. Kennedy H. Trauma in childhood: signs and sequelae as seen in the analysis of an adolescent. The Psychoanalytic Study of the Child 1986; 41:209-219.
52. Gunnar MR, Porter FL, Wolf CM, Rigatuso J, Larson MC. Neonatal stress reactivity: predictions to later emotional temperment. Child Dev 1995; 66: 1-13.
53. Davis M, Emory E. Sex differences in neonatal stress reactivity. Child Dev 1995; 66: 14-27.
54. Goldman R. The psychological impact of circumcision. BJU International 1999; 83, Suppl. 1:93-102.
55. Rhinehart J. Neonatal circumcision reconsidered. Transactional Analysis Journal 1999; 29(3):215-221.
56. Boyle GJ, Goldman R, Svoboda JS, Fernandez E. Male circumcision: pain, trauma and psychosexual sequelae. .J Health Psychol 2002;7(3):329-43.
57. Gerharz EW, Ransley PG, Woodhouse CRJ. Urinary retention, erectile dysfunction and penile anaesthesia after circumcision: a mixed dissociative (conversion) disorder. Int Urol Nephrol 2005;37(3):525-
58.Frisch, M., Lindholm, M., and Grønbæk, M., "Male Circumcision and Sexual Function in Men and Women: A Survey-based, Cross-sectional Study in Denmark," International Journal of Epidemiology (2011); 1-15.
59. "Circumcision Policy Statement." Circumcision Policy Statement. N.p., n.d. Web. 26 Aug. 2012. <http://pediatrics.aappublications.org/content/103/3/686.full>.
60. Belluck, Pam. "Group Backs Ritual 'Nick' as Female Circumcision Option." The New York Times. The New York Times, 07 May 2010. Web. 23 Aug. 2012.
1. Brewer D. Scarification and male circumcision associated with HIV infection in Mozambican children and youth. Webmedcentral 2011;2(9):WMC002206.
2. Darby, R. L., & Van Howe, R. S. (2011). Not a surgical vaccine: there is no case for boosting infant male circumcision to combat heterosexual transmission of HIV in Australia. Australian and New Zealand Journal of Public Health, 35, 459-465.
3. Green, L. et al., "Male Circumcision and HIV Prevention: Insufficient Evidence and Neglected External Validity," American Journal of Preventive Medicine 39 (2010): 479-82.
4. Thomas AG, Bakhireva LN, Brodine SK, Shaffer RA Prevalence of male circumcision and its association with HIV and sexually transmitted infections in a U.S. navy population. Abstract no. TuPeC4861. Presented at the XV International AIDS Conference, Bangkok, Thailand, July 11-16, 2004.
5. Bliss Jr DP. Healey PJ, Waldhausen JHT. Necrotizing fasciitis after Plastibell circumcision. J Pediatrics 1997;31:459-62.
6. Cook J, Parish JA, Shooter RA: Acquisition of Staphylococcus aureus by newborn babies in a hospital maternity department. Br Med J 1938;1:74-8.
7. Hurst V. Transmission of hospital staphylococci among newborn infants. Pediatrics 1960;25:204-14.
8. "What Are the Key Statistics about Breast Cancer in Men?" What Are the Key Statistics about Breast Cancer in Men? N.p., n.d. Web. 23 Aug. 2012. <http://www.cancer.org/Cancer/BreastCancerinMen/DetailedGuide/breast-cancer-in-men-key-statistics>.
9. "What Are the Key Statistics about Penile Cancer?" What Are the Key Statistics about Penile Cancer? N.p., n.d. Web. 23 Aug. 2012. <http://www.cancer.org/Cancer/PenileCancer/DetailedGuide/penile-cancer-key-statistics>.
10. Shulman J, Ben-hur N, Neuman Z. Surgical complications of circumcision. Am J Dis Child 1964; 107:149-54.
11. Patel H. The problem of routine infant circumcision. Can. Med. Assoc. J 95 (Sept 10, 1966): 576-581.
12. Gee WF, Ansell, NF. Neonatal circumcision: a ten year overview; with comparison of the Gomco clamp and the Plastibell device. Pediatrics 1976; 58: 824-7.
13. Kaplan GW. Complications of circumcision. Urol Clin N Amer 1983;10:543-549.
14. Griffiths DM. Atwell JD. Freeman NV. A prospective survey of the indications and morbidity of circumcision in children. European Urology 1985 11(3):184-7.
15. Williams N, Kapila L. Complications of circumcision. Br J Surg 1993; 80:1231-36.
16. Killick CJ, Barton CJ, Aslam S, Standen GR. Prenatal diagnosis in factor XIII-A deficiency. Arch Dis Child Fetal Neonatal Ed 1999;80:F238-F239.
17. Hiss J, Horowitz A, Kahana T. Fatal haemorrhage following male ritual circumcision. J Clin Forensic Med 2000;7:32-4.
18. Corbett HJ, Humphrey GME. Early complications of circumcisions performed in the community. Br J Gen Pract 2003;53(496):887-8.
19. Newell TEC. Judgement of inquiry into the death of McWillis, Ryleigh Roman Bryan. Burnaby, B.C.: British Columbia Coroner's Service, Monday, 19 January 2004.
20. Brimhall JB. Amputation of the penis following a unique method of preventing hemorrhage after circumcision. St Paul Med J 1902; 4: 490
21. Lerner BL. Amputation of the penis as a complication of circumcision. Med Rec Ann 1952;46:229-31.
22. Levitt SB, Smith RB, Ship AG. Iatrogenic microphallus secondary to circumcision. Urology 1976; 8: 472-4.
23. Izzidien AY. Successful replantation of a traumatically amputated penis in a neonate. Journal of Pediatric Surgery April 1981,16(2):202-203.
24. Hanash KA. Plastic reconstruction of partially amputated penis at circumcision. Urology 1981; 18(3): 291-3.
25. Azmy A, Boddy SA, Ransley PG. Successful reconstruction following circumcision with diathermy. Br J Urol 1985; 57: 587-8.
26. Yilmaz AF, Sarikaya S, Yildiz S, et al. Rare complication of circumcision: penile amputation and reattachment. European Urology (Basel) 1993; 23(3): 423-424.
27. Audry G, Buis J, Vazquez MP, Gruner M. Amputation of penis after circumcision--penoplasty using expandable prosthesis. Eur J Pediatr Surg 1994; 4: 44-5.
28. Hanukoglu A, Danielli L, Katzir Z, Gorenstein A, Fried D. Serious complications of routine ritual circumcision in a neonate: hydro ureteronephrosis, amputation of glans penis, and hyponatraemia. Eur J Pediatr 1995; 154: 314-5.
29. Gluckman GR et al. Newborn Penile Glans Amputation During Circumcision and Successful Reattachment. Journal of Urology (Baltimore), vol. 153 no. 3 Part 1 March 1995 pp. 778-779.
30. Strimling BS. Partial amputation of glans penis during Mogen clamp circumcision. Pediatrics 1996; 97: 906-7.
31. Neulander E, Walfisch S. Kaneti J. Amputation of distal penile glans during neonatal ritual circumcision -- a rare complication. Br J Urol 1996; 77: 924-5.
32. Sherman J, Borer JG, Horowitz M, Glassberg KI. Circumcision: successful glanular reconstruction and survival following amputation. J Urol 1996; 156: 842.
33. Van Howe RS. Re: circumcision: successful glanular reconstruction and survival following traumatic amputation (Letter). J Urol. 1997;158:550.
34. Coskunfirat OK, Sayiklkan S, Velidedeoglu H.. Glans and penile skin amputation as a complication of circumcision (letter). Ann Plast Surg 1999;43(4):457.
35. Siegel-Itzkovich J. Baby's penis reattached after botched circumcision. BMJ 2000;321:529.
36. Park JK, Min JK, Kim HJ. Reimplantation of an amputated penis in prepubertal boys. J Urol 2001;165:586-7.
37. Holt LE. Tuberculosis acquired through ritual circumcision. JAMA 1913;LXI(2):99-102.
38. Reuben MS. Tuberculosis from ritual circumcision. Proceedings of the New York Academy of Medicine 1916; (December 15): 333-334.
39. Rosenstein JL. Wound diphtheria in the newborn infant following circumcision. J Pediatr 1941;18:657-8.
40. Gairdner D. The fate of the foreskin. A study of circumcision. BMJ 1949; 2: 1433-37.
41. Scurlock JM, Pemberton PJ. Neonatal meningitis and circumcision. Med J Aust 1977;1:332-334.
42. Cleary TG, Kohl S. Overwhelming infection with group B beta-hemolytic streptococcus associated with circumcision. Pediatrics, Vol 64, no 3, (September 1979), pp. 301-303.
43. Hiss J., Horowitz A., Kahana T. Fatal haemorrhage following male ritual circumcision. J Clin Forensic Med 2000;7:32-4.
44. Newell TEC. Judgement of inquiry into the death of McWillis, Ryleigh Roman Bryan. Burnaby, B.C.: British Columbia Coroner's Service, Monday, 19 January 2004.
45. Paediatric Death Review Committee: Office of the Chief Coroner of Ontario. Circumcision: a minor procedure? Paediatr Child Health 2007;12(4):311-2
47. Bollinger, D. and Van Howe, R. , "Alexithymia and Circumcision Trauma: A Preliminary Investigation," International Journal of Men's Health (2011); 184-195.
48.Glover E. The ‘screening’ function of traumatic memories. Int J Psychoanal 1929; 10:90-93.
49. Cansever G. Psychological effects of circumcision. Br J Med Psychol 1965; 38: 321-31.
50. Flaherty, JA. Circumcision and Schizophrenia. J Clin Psychiatry 1980; 41: 96-98.
51. Kennedy H. Trauma in childhood: signs and sequelae as seen in the analysis of an adolescent. The Psychoanalytic Study of the Child 1986; 41:209-219.
52. Gunnar MR, Porter FL, Wolf CM, Rigatuso J, Larson MC. Neonatal stress reactivity: predictions to later emotional temperment. Child Dev 1995; 66: 1-13.
53. Davis M, Emory E. Sex differences in neonatal stress reactivity. Child Dev 1995; 66: 14-27.
54. Goldman R. The psychological impact of circumcision. BJU International 1999; 83, Suppl. 1:93-102.
55. Rhinehart J. Neonatal circumcision reconsidered. Transactional Analysis Journal 1999; 29(3):215-221.
56. Boyle GJ, Goldman R, Svoboda JS, Fernandez E. Male circumcision: pain, trauma and psychosexual sequelae. .J Health Psychol 2002;7(3):329-43.
57. Gerharz EW, Ransley PG, Woodhouse CRJ. Urinary retention, erectile dysfunction and penile anaesthesia after circumcision: a mixed dissociative (conversion) disorder. Int Urol Nephrol 2005;37(3):525-
58.Frisch, M., Lindholm, M., and Grønbæk, M., "Male Circumcision and Sexual Function in Men and Women: A Survey-based, Cross-sectional Study in Denmark," International Journal of Epidemiology (2011); 1-15.
59. "Circumcision Policy Statement." Circumcision Policy Statement. N.p., n.d. Web. 26 Aug. 2012. <http://pediatrics.aappublications.org/content/103/3/686.full>.
60. Belluck, Pam. "Group Backs Ritual 'Nick' as Female Circumcision Option." The New York Times. The New York Times, 07 May 2010. Web. 23 Aug. 2012.
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