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该不该给男孩割掉包皮?

更新时间:2016-5-13 8:25:26 来源:纽约时报中文网 作者:佚名

Should You Circumcise Your Child?
该不该给男孩割掉包皮?

Snip or don’t snip?

切还是不切?

In 2012, the American Academy of Pediatrics declared that the benefits of circumcising boys outweighed the risks of the procedure. They cited health benefits that, while not great enough to warrant a recommendation for all males to undergo the procedure, were significant enough that it should be available to all, and that it should be covered by insurance. Not long after, the CDC concurred.

2012年,美国儿科学会(American Academy of Pediatrics)宣布,男孩做包皮环切手术的好处大于风险。他们提到,虽然其健康收益没有大到应该建议所有男性都割包皮的地步,但也已经足够显著,因此应该向所有人提供这一手术,并将其纳入医疗保险。不久,美国疾病控制与预防中心(CDC)表示赞同。

Let’s look at the evidence. For years, pediatricians have cited studies that show that being uncircumcised is a risk factor for developing a urinary tract infection. They point to research that shows that circumcised penises have lower levels of yeast and bacteria. Even more compelling, cohort studies showed that there was a tenfold increase in the rate of urinary tract infection in boys who were uncircumcised versus those who were.

让我们看看证据吧。多年来,儿科医生一直声称,有研究表明不割包皮是引发尿路感染的一个风险因素;还有研究表明割过包皮的阴茎所携带的酵母菌和细菌的数量较少。更引人注目的是,队列研究表明,未割包皮的男孩发生尿路感染的几率,比割过包皮的男孩高出10倍。

The actual rates of urinary tract infection were 1.1 percent versus 0.1 percent, for an absolute rate difference of 1 percent. This means that 100 boys would need to be circumcised to prevent one urinary tract infection. Other studies say the number might be higher.

两者的尿路感染实际发病率分别是1.1%和0.1%,绝对差为1%。这意味着为了避免一个男孩发生尿路感染,要给100个男孩割包皮。其他研究显示这一数字可能还要更高一些。

It’s really hard to argue that this decrease is worth a permanent, surgical procedure. It’s especially hard to argue given that we don’t really have data from randomized controlled trials. It’s possible that there’s something else different between boys who were circumcised and those who were not, especially since the vast majority (more than 80 percent) of boys in these studies were circumcised. Regardless, this amount of benefit seems to pass the threshold for coverage by insurance (which is low), so the procedure is available.

真的很难证明,为了这种幅度的降低而去做具有永久性影响的外科手术是值得的。由于我们并没有随机对照试验数据,要证明这一点更显得困难重重。割过包皮的男孩和没割过包皮的男孩之间可能还存在其他差异,尤其是考虑到参与这些试验的男孩绝大部分(超过80%)都割过包皮。不过,这种好处似乎已经超出了被纳入医保所需达到的标准(相关标准是很低的),因此医保会为人们提供这种手术。

Another benefit sometimes mentioned is a reduced risk of penile cancer. Case control studies have reported that uncircumcised men have a three times greater chance of developing penile cancer. Again, this is relative: Penile cancer is very rare in the United States, so the actual risk reduction from circumcision is very, very small. It’s estimated that more than 300,000 infants might need to be circumcised to prevent one case of penile cancer.

有时会被提及的另一个好处是降低罹患阴茎癌的风险。病例对照研究表明,没割过包皮的男性得阴茎癌的几率是割过包皮者的三倍。同样,这一点也是相对的:阴茎癌在美国极为罕见,因此割包皮对降低实际发病率的作用,是微乎其微的。据估计,为了防止一个人罹患阴茎癌,可能需要给超过30万名幼儿割包皮。

Some argue that circumcision can reduce the chance of contracting a sexually transmitted infection later in life. A systematic review of 26 studies found that circumcised men are at a lower risk of syphilis or chancroid. There might be some protection against herpes, but it’s less significant.

一些人认为,割包皮可以降低日后感染上经性接触传播的疾病的几率。有研究人员在系统地汇总了26项研究后发现,割过包皮的男性患梅毒或软性下疳的风险较低。割包皮对预防疱疹或许也有帮助,但效果不那么显著。

The strongest case for circumcision can be made as a benefit against the transmission of H.I.V. In Africa, where H.I.V. is much more prevalent, randomized controlled trials of circumcision have been performed. The results were quite convincing. Absolute rate reductions of 1-2 percent over one to two years were seen. Some estimate that for 10 to 20 males circumcised, one fewer man might contract H.I.V. over a lifetime. One study likened circumcision to a vaccine of high efficacy.

关于割包皮的好处,最有力的说法或许是可以阻止艾滋病的传播。在艾滋病较为普遍的非洲,已经做过关于包皮环切术的随机对照试验。其结果相当有说服力。一到两年时间里,发病率绝对值下降了1%-2%。有人估计,每有10-20名男性割包皮,就可以避免一名男性在一生当中感染艾滋病毒。一项研究把包皮环切术比作高效疫苗。

Again, though, these results apply to countries with a much higher prevalence of H.I.V. than we see in the United States. The protection afforded, therefore, is much less significant here.

不过还是要指出,这些研究结果只适用于艾滋病发病率比美国高得多的国家。在美国,割包皮所能带来的预防作用远没有那么显著。

Opponents of circumcision point to its potential downsides. Surgical complications, while rare, are greater than zero. Pain is a concern as well; evidence exists both to support and rebut the notion that infants recover quickly.

反对包皮环切术的人士指出它具有潜在的负面影响。手术并发症虽然不常见,但绝非没有。疼痛也是一个让人担心的问题;另外,对于幼儿很快就可以恢复这一观点,既存在支持性证据,又存在反驳性证据。

More prominent concerns focus on sexual function and satisfaction. Opponents argue that the foreskin, like much of the penis, contains many nerve endings. It also protects the head of the penis; without it, the penis might become less sensitive over time.

更为引人注目的顾虑集中在性功能和性满意度方面。反对者称,包皮和阴茎的很多部分一样含有大量神经末梢。它还能对龟头起保护作用;割包皮可能会让阴茎在未来变得不那么敏感。

But does this actually happen? A recent study in the Journal of Urology, discussed in The New York Times, measured penile sensitivity in circumcised and uncircumcised men and found no real difference. It wasn’t the first, or the best, study to look at this.

但这种情况真的会发生吗?《纽约时报》讨论过《泌尿学杂志》(Journal of Urology)近期发表的一项研究的成果。研究人员分别测量了割过包皮的男性和没割过包皮的男性的阴茎敏感度,没有发现真正的差异。这并非第一项,也并非最有说服力的一项得出这一结论的研究。

A randomized controlled trial of more than 2,700 men in Kenya found that after circumcision they experienced increased sensitivity, and that they had an easier time reaching orgasm. A systematic review and meta-analysis found that circumcision was unrelated to premature ejaculation, erectile dysfunction or difficulty achieving orgasm.

在肯尼亚,一场共有2700名男性参加的随机对照试验表明,割包皮后他们变得更加敏感,也更容易达到高潮。有研究人员在进行系统性汇总和综合分析后发现,割包皮和早泄、勃起功能障碍或者难以达到高潮无关。

Over all, the evidence arguing for and against circumcision fails to make a compelling case in either direction. The benefits, while arguably real, are small; likewise the harms. In such cases, we usually leave the decision to the patient.

总之,用以支持和反对割包皮的证据,都无法为任何一方提供令人信服的理由。好处无疑是存在的,但并不大,坏处也一样。鉴于此,我们常常把决定权留给个人。

There is, of course, an ethical problem here, since the choice is almost always made by parents, not by the boys themselves. Circumcision is irreversible, and many argue, quite stridently, that this is “genital mutilation” inflicted on children for no reason.

当然了,这其中还存在伦理上的问题,因为做决定的通常是男孩的父母而非男孩本人。包皮环切术具有不可逆性,很多人的批评相当尖锐,说这是毫无理由地让幼儿承受“生殖器伤害”之苦。

All cards on the table: I’m Jewish, and I’m circumcised, as are both my sons. The procedure has a spiritual weight in my community. When confronted by people who use terms like mutilation, I generally recoil. Circumcising my boys was a personal decision for my wife and me, and I understand the various arguments for and against. People angry about this choice seem to imagine that we haven’t thoroughly considered it.

实话实说:我是犹太人,我做了包皮环切手术,我的几个儿子也做了。这种手术在我们这个群体里具有宗教方面的重要性。为儿子行割礼是我和妻子的个人决定,而且我了解支持和反对割礼的各种说法。对这种选择感到恼火的人似乎以为我们考虑得不够充分。

I also live with the knowledge that it’s possible that my children might have chosen differently. But we also have to recognize that parents make many, many decisions for their children with a greater and more meaningful impact on them than circumcision. That’s what parents do. Assuming that this is the most consequential one we might have made about our boys’ lives, and focusing so much attention on it — when evidence makes the value of either choice unclear — seems out of proportion.

我也知道,我的孩子们可能做出不同的选择。但与此同时我们必须明白,父母会帮孩子做出太多影响比割礼更大、更深远的选择。这是为人父母者的职责所在。目前还没有证据能够清楚地表明,割或不割哪种选择更有益,如果假设这可能是我们做过的对儿子们的生活影响最大的选择之一,并且过于强调这一点,未免显得小题大作。

That doesn’t mean opponents don’t have a point. Circumcision is much rarer in most other industrialized countries. Health organizations in those countries don’t advocate the procedure as we do in the United States. An argument can also be made for waiting until boys are old enough to make a decision for themselves. A number of factors make that difficult, though. It’s a more complicated procedure then, with greater risks and higher costs.

但这并不意味着反对者的话没有道理。在其他大多数工业化国家里,包皮环切手术要少得多。那些国家的健康组织并不像我国的类似组织那样提倡做这种手术。人们可以主张,应该等到男孩长到足够大再自行决定。但届时一些因素会让做决定变得更困难。长大后手术会更复杂,风险更高,费用也更高。

Given that religion and culture are tied up in this, it’s clear that this issue won’t be decided soon. It’s also clear that evidence won’t make anyone’s choice easier. In the end, the decision as to whether parents opt to have their babies circumcised will remain a personal one.

由于牵扯到宗教和文化方面的考量,这显然不是一件很快就能产生最终答案的事情。摆在眼前的各种证据显然也不能帮助任何人更为轻松地作出决定。到最后,父母是否选择给小孩做包皮环切手术仍然会是个人决定。

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