Danielle Lee: Good evening, Jacksonville, and happy Saturday. I am Danielle Lee. Welcome to The Conversation with Dr. Ali Kasraeian. As always, you too can join the conversation. Give us a call, 340-1045. It is our first show of the new year, with The Conversation. Dr. Ali, welcome. How are you?
Ali Kasraeian: I am good. I am good. Happy new year.
Danielle Lee: Happy new year. We were talking earlier before the show, and pretty much the topic of the show today is the question, to cut or not to cut?
Ali Kasraeian: Yes, to cut or not to cut, that is the question. We are talking about a very controversial procedure, basically the circumcision, and I’ve been wanting to do this show for a very, very long time, because it’s a question that comes up far too often and all too often. And the questions are very, very reasonable as to whether or not someone should do a circumcision for their newborn son. And the question comes up through the course of life. People at all ages bring up the question, moms, dads, and also adult men, whether or not they should have a circumcision.
Today we’re going to talk about and navigate the risk-benefits of both sides of the discussion, and you would be surprised at how passionate people are on both sides of the fence on this argument. To help lead this discussion and guide us with his knowledge is a good friend of mine, Aaron Spitz, who’s not only a urologist and a fertility expert from Los Angeles, California, and a correspondent with the show “The Doctors”, but he is an author as well.
He is working the new release that’s coming up in February of “The Penis Book”, which is basically a comprehensive guide to everything you’d want to know about the penis, which surprisingly, you’d think … This seems like a very, very simple organ, but it’s a very elegant and complicated organ with a lot of different medical issues that could be related to it. A book like this, for both physicians and non-physicians, is a very, very added armamentarium and a tool for all of our lives. So Aaron, thank you for joining us.
Aaron Spitz: Oh, it’s my pleasure, Ali. It’s great to be here, and think it’s appropriate on this cold snap that we’re going to be talking about turtlenecks.
Ali Kasraeian: So let me ask you, what inspired you to write this book?
Aaron Spitz: Well, I do happen to own a penis, so that was part of it, but no, in all seriousness, as a urologist I subspecialize in male sexual health and male reproductive health, and so the genitals, the penis, is an important part of my daily work in terms of helping other people that face difficulties or have questions about their penis. I have extensive experience communicating about these kinds of topics to a larger audience on television, where I’ve appeared numerous times on a television show called “The Doctors”, talking about a lot of these topics.
Writing a book enabled me to take that experience with communicating about delicate issues, my expertise, and all the help that I’ve been able to provide patients in a one-on-one basis, and expand it to a much larger audience, and hopefully provide help and guidance and reassurance to a lot more people all at once.
Ali Kasraeian: Well, I’ll tell you, reading over this book, and I looked over the chapter on this very topic over the past few days, it does a wonderful job of not only simplifying complicated topics about a very complicated organ for both lay people who are not physicians to take in the information in a way they can easily understand, but also it allows physicians to be able to understand complicated information in a way that they can easily communicate that information to their physician. So I think you’ve done an amazing job with a book that I think will be helpful to the broad spectrum of men and people who care about men in their lives. So thank you very much for adding that to our coffee tables.
Aaron Spitz: Or bedroom side tables, as it were.
Ali Kasraeian: I’ll tell you, it’s a great book, I think. I encourage everyone to get this book. So when it is available to all of us?
Aaron Spitz: It hits the stores on February 20th, but it’s actually available to pre-order now on Amazon or Barnes & Noble websites. But it will actually physically be shipped or be able to be bought in stores on February 20th.
Ali Kasraeian: With our topic today, circumcision, why is a circumcision so controversial?
Aaron Spitz: Circumcision is controversial because it’s one of those elective procedures that is often performed on people without their own personal consent. For many people, circumcision is performed on them when they are infants; however, there are also many men who undergo circumcision with their own full consent. But because of the nature of it being a medical procedure that is elective, but performed on someone before they’re of an age of consent, it is the center of controversy.
Ali Kasraeian: And you know, even people have been, as we posted this show, talk about things that they put on, where this is a crime against … it’s a sex crime and things of that nature. The emotions with regards to circumcision are very, very polarized, where people feel very strongly in either direction, where people should absolutely have a neonatal circumcision, which is basically a procedure to remove the foreskin around the penis. And we’ll talk through the length of this show about the benefits of doing a circumcision, which there are many, and also the potential risk associated with the procedure, which fortunately there are few. So that fuels a lot of these conversations where you can have people that are very passionate on one side versus the other, and the scientific discussion really doesn’t show much harm in the actual procedure.
That becomes a very difficult discussion for people that are very passionate about this being a harmful procedure for a neonate, where when people have circumcision as an adult, even though it’s still very well tolerated, the discomfort, the pain, and the potential risk of infection and complications, although small, are still higher than when they’re done when the men are neonates, or when they’re just born.
Aaron Spitz: Yes, this is true. There are certain key benefits of a circumcision that are only experienced if the circumcision is done when the male is an infant, and then there are other benefits of circumcision that are still realized even if it’s done as an adult. But because there are certain key benefits that only occur if the circumcision is performed as an infant, it makes the controversy that much more important, because if you were to look at the controversy and say, “Well, let’s just ban circumcision until that male is old enough to give consent. We’re not saying that you cannot have a circumcision, but we’re going to postpone it,” the problem is that the vastly reduced risk of getting penis cancer is no longer realized.
One of the big benefits of circumcision is it all but practically eliminates a man’s risk of ever getting penis cancer, if it’s done when the man is an infant. But if a circumcision is performed when the man is an adult, that benefit no longer occurs, and it probably has to do with the exposures of the foreskin over the early years of that male’s life and the molecular and chemical reactions that occur in the skin that no longer occurring once that skin is removed as an infant.
So because certain key benefits are removed, it makes this not just a controversy over personal choice, but also what are the actual medical benefits you may or may not be allowing your child to have? Another key risk that is removed or greatly reduced by circumcising an infant is their risk of developing a urinary tract infection while they are an infant. When an infant gets a urinary tract infection, the stakes are much higher than when, say, an adult gets a urinary tract infection. And if that male child has a circumcision, their risk of getting a urinary tract infection is significantly reduced, and it’s reduced during that really vulnerable period in their life. It’s reduced from, say, one in 12 for circumcised babies versus only one in three if you’re not circumcised. So you get four times the risk of your baby boy getting a urinary tract infection if you don’t circumcise him in that critical period of time.
Ali Kasraeian: You know, one of the things that’s very interesting about this discussion is a lot of times in the times that we’re doing adult circumcisions, we have to keep in mind that we are … to put into the conversation, adult circumcisions, not an insignificant amount of time, are being performed because people are having issues with their foreskin, and so when …