Introduction to Circumcision

I thought I would post this link at the top of my topic, becuase I am so impressed by it. It does a very good job of telling the pro and anti circ position of most of the issues regarding male circumcision, and then it gives a very reasonable explanation of what is and what isn't. It even grants some points given from the pro circumcision crowd. link

One of the most serious issues I want to talk about is circumcision. I like this topic for a number of reasons. It isn't one of the same tired controversial issues that everyone gets bored about. This topic also makes people very uncomfortable. Getting people out of their comfort zone is always fun.

This is going to be a very long and complicated issue. It breaks down into so many subcategories, and I feel like I need to cover all of them to really do this issue justice. I will do as best I can to pack in as much relevant information as possible in such a small space. The amount of information on the subject is overwhelming. I will do my best to try and walk the line between not giving you a complete picture and providing unnecessary information. For your viewing pleasure this is what you have to look forward to.

I. Circumcision from a Biblical perspective

II. History of circumcision

III. Female Circumcision vs Male Circumcision

IV. Medical reasons to circumcise(conclusions)
A. UTIs
B. Cleanliness
C. Cancer
D. Phimosis
E. STDs/AIDS

V. Cultural reasons to circumcise
A. Religion
B. Social

VI. Why not circumcise
A. Benefits of intactness
B. The procedure itself

VII. The legality of circumcision

Well as you can see this is going to be a long topic. I will publish each topic whenever I can find time to do so. Time is hard to come by. Also lets try to be mature about this. Whenever we talk about down low giggles and laughter tend to follow.

Lastly I don't want to blog using videos, but I thought this one was particularly interesting. This is an abridged version of a documentary done on circumcision. It is anti-circumcision, but it is one of the only documentaries I have seen that lets both sides have their say.

video

Circumcision in the Bible

As most of my friends are Christians, I figure I ought to devote a blog to the Biblical aspect of circumcision. What are we as Christians supposed to feel about circumcision?

Out of all the issues presented in the Bible, few are harder to deal with than circumcision. Different passages seem to contradict each other. The first part of the Bible deals with the creation story, including the creation of people. The first chapter of Genesis claims that all of God's creations are "good" and that we are "made in God's image." Paul later claims that, "God has arranged the parts in the body, every one of them, just as he wanted them to be." 1 Corinthians 12:18 Paul speaks frequently in the New Testament that "circumcision is useless," or "circumcision is nothing." He goes so far as to call circumcisers "mutilators of the flesh" Philippians 3:14.

Why would God then command his chosen people to circumcise themselves? (Genesis 17:10-14) This is a rather difficult question to answer. It is clear that the New Testament is adamantly opposed to the procedure, yet God commands his chosen people to circumcise. It is a mystery that I have been struggling with and cannot come up with a logical answer. Then again, this isn't as bizarre as requiring a raper to marry their victim. (Deuteronomy 22:28-29) The one thing that is clear on the subject is that circumcision is not required for Christians. If anything circumcision is discouraged and seen as a way of not accepting Jesus.

History of Circumcision

In order to understand circumcision as it is today, it is first necessary to know how it came to be. Most people start believe that circumcision started off in ancient Israel, yet it is clear that circumcision started long before that. It is also clear that the origins of circumcision are lost in antiquity. Many trace circumcision back to Egypt using this picture.



While this picture has virtually become the logo for those that advocate for circumcision, the original picture looks more like this.

*Note that the man on the left is being held down.

Even though this provides some evidence of circumcision in ancient Egypt, to date no circumcised mummies have been found, but some statues show what may be a superincision (cutting a slit in the upper side of the foreskin, or dorsal slit). (1)

The most common historical circumcision that we think of today is Jewish circumcision. However there is evidence that the procedure is radically different than the one performed today. In ancient times, only the skin that was past the glans was cut. Today the skin is cut all the way behind the glans, and often removes the frenulum. (1)(2)

Throughout much of history, circumcision was limited to Muslims, Jews, and no one else. In the 18th century, sexual enjoyment was seen as sinful, and had potential negative health consequences. Masturbation was seen as the worst of all forms of sexual enjoyment. (1) Doctors believed that insanity, vision and hearing problems, epilepsy, and mental retardation were all caused by excessive masturbation. In the late 19th century a cure was found for masturbation.(or at least they thought) Circumcision was seen a miracle procedure that would help rid the world of masturbation. Of course circumcision did not cure masturbation at all, but its proponents used it nonetheless. (2)

In 1877 John Harvey Kellogg helped to popularize modern circumcision in America. Unlike the previous versions, this was specifically performed to do harm. He is quoted that the procedure should be associated with punishment and is best performed without anesthetic. (3)

Even though masturbation was dropped as a medical problem, doctors have continued to support circumcision for health reasons. According to historian Fredrick Hodges, there is a trend in American medicine. It turns out that whatever disease is feared at the time, circumcision advocates will use circumcision as a cure. During WWII when Venereal disease was a big concern, there were several quite frankly racists articles written about how it came from black people. It explained how they could not be trusted to clean themselves and should therefore have forced circumcisions. In the 50s and 60s Cancer was the national scare, circumcision was used as a cure. During the 70s and 80s when AIDs was the big concern, naturally, circumcision was used. (4)(6)

What most people don't realize is this was not limited to males in this time. Up until the late 50s, female circumcision was promoted in reputable health journals, and it was used for the same health benefits as male circumcision.(5)(1) At the time doctors would remove everything they assumed was non-essential. They would remove the appendix, tonsils, the clitoris, and both the male and female foreskins of health individuals. Of these, only male circumcision is left as a solution looking for a problem. (5)(6)

In the post WWII world every civilized nation in the world dropped circumcision with the exception of the United States. Today if you are circumcised, statistically speaking, you are Jewish, Muslim, or American. (1)

Well this obviously brought up a lot of topics that I will discuss later. At least that is a vague overview of the issue.

(1) Marked in your Flesh - Glick
(2) Questioning Circumcision: A Jewish Perspective - Ronald Goldman Ph.D.
(3) Circumcision the Hidden Trauma: How an American Cultural Practice Affects Infants and Ultimately Us All - Ronald Goldman Ph.D.
(4) AAP policy Statement
(5) Rape of Innocence - Robinett
(6) Whose Body Whose Rights, Dillonwood Productions

Female Circumcision vs Male Circumcision

Cliffs Notes


The horrors of female circumcision reverberate all throughout today's mass media. Male circumcision is often dismissed as nothing or not even talked about at all. Often in conversations people will tell me that "it is impossible to compare male and female circumcision." Well as the definition of a compare is "to consider or describe as similar," I believe I can. In both male and female circumcision part of the genitals are being amputated. Eureka! Now that we have determined that they can indeed be compared lets be a little more serious about the matter.

One reason we have such a hard time getting through to African cultures about female circumcision is they think we are all hypocrites. We criticize them for circumcising a female in such horrible conditions, when a male is next in line. They also see us circumcising a large percentage of our males, so they see no reason why we have any room to talk. This leaves the most common argument that female circumcision is so much worse than male circumcision. Well in some ways they are right. The kind of circumcision that you see in the news is much worse than what is commonly practiced here. However, the situation is much more complex than that.

Before I start, there are some people whom this will not satisfy. They will point out some differences in what I am trying to compare. Notice I say they are "similar" not identical. Also to help satisfy those people who get angry when I do this, I am not downplaying female circumcision. I agree. It is sick. That isn't the point at all. The point is to find parallels.

note: I have gotten some complaints that I don't talk about other complications from the procedures (death from the procedure, infections, and infant mortality) This is much harder to do, but I will try and do it quickly. As far as deaths go, more men die in circumcision than women. This is becuase many more men are circumcised than women. It is true that a greater percentage of circumcised women die or have infections. However, those women are operated on in mostly 3rd world countries with a shard of glass. This happens to the men there too and they also die in large numbers. The discrepancy in the percentage of infections/deaths comes from the US, where we have a trained medical staff and sanitary conditions. As a result it is hard to have any meaningful data. As far as childbirth goes, well Men don't deal with that at all obviously. As most anti FGM posters rarely talk about it, information about the subject was sketchy at best from my sources. While I am sure FGM contributes to deaths in childbirth and infant mortality, who is to say that the death would not have happened had she not been circumcised? As I stated earlier, another reason for lack of prevalent data is that FGM activists don't concentrate on it.

1. The most mild form of female circumcision is a prick or simple bloodletting. This is actually more common for girls than most people think. A prick is also becoming more and more common for Jewish boys, becuase their parents want a "bris" without putting their child in the most pain he has ever experienced. These two actually compare really well. Baring infection, neither has any long term damages. Both are mildly painful. Both are done for religious reasons. Neither serves a practical purpose.

2. Removal of the female prepuce is next on the list. Contrary to what most people think, this is actually the most common type of female circumcision. This type of circumcision may include the labia or clitoral hood. They both serve a similar function as the male foreskin and are biologically homologous organs. The purpose of this tissue is to cover the glans. For the female this is the clitoral glans. For the male, this is the head of the penis. Either surgery will have the same result. Both will dry the exposed glans out and leave it calloused. Unlike the female prepuse, the foreskin acts as the males main lubricant and has many more nerve endings than the female prepuce. Both males and females can usually experience sexual pleasure and orgasms, but it is often greatly reduced.

3. Clitorectomy. This procedure is hard to compare to anything for the male. Many angry women will chant that "Its like removing the entire penis you sexist pig!!!" While I am sure they have the best of intentions, that notion is absurd. A woman who has had a clitorectomy can have sex and has often been able to have orgasms. A man with a penectomy cannot function in any way sexually. He cannot even have sex let alone have an orgasm.

Some people say that a very tight circumcision is the equilivant of a clitorectomy. A very tight circumcision removes a similar amount of tissue as a clitorectomy. It can also make normal living difficult as well as normal sexuality. Some poor circumcision jobs have make erections painful and can even tear the skin causing bleeding. It would also remove all sensitive areas around the glans such as the frenulum, and frenular band. This is probably a little less severe than a clitorectomy for the simple fact that a man would still have his glans and the woman would not. As they are biologically homologous structures, this discrepancy cannot be ignored. There is a very rare procedure called a glansectomy that would remove the males glans. This procedure is so rare that there is very little information about it, but given that this procedure would take away all of the males sensitive tissue, and would relocate the end of the urethra, it is probably more sever than a clitorectomy. A clitorectomy would remove most of the sensitive tissue, but it is nearly impossible to remove the entire thing, as well as many other internal sexual organs making some sexual pleasure still possible. In conclusion the clitorectomy is probably somewhere in between the two.

4. Infibulation or Excision of all the external genitalia followed by sewing the remaining tissue together so that a small opening is left for menstruation and urination. Now the comparisons get harder and harder. I would compare this to a penectomy, but again, a male without a penis cannot function in any way shape or form sexually. Both procedures make urination interesting to say the least, but women who have had infibulation done can still have sex, especially after the part that is sown shut is opened. It might be very painful, but it is still possible. I would have to say this is somewhere between a glansectomy and a penectomy, although probably closer to a penectomy.

One a side note, a penectomy is uncommon but not unheard of after a botched circumcision.

I introduce topic for two main reasons. One reason is I find that we tend to accept our cultural norms without question and reject others cultural norms. One classic example of this is the difference between male and female genital cutting. Through our western eyes the male version seems like a little snip while the female version seems unthinkable. However when you break it down to its core, it is very similar. While each stage of genital cutting does not have a 100% match, they all have a close cousin. The other topic is very simple. I make comparisons to female circumcision occasionally in my other blogs. Anyone who reads those blogs without first taking time to read this would probably be very confused.


The information of female circumcision comes from these sources. The male equivalents comes from further research which I will elaborate on in subsequent blogs.

http://www.fgmnetwork.org/index.php (October 2008)recognizes types 2 – 4

Mason, Christine, Exorcising Excision: Medico-Legal Issues Arising From Male and Female Genital Surgery in Australia, Journal of law and Medicine, Aug 2001, Vol 9, no 1: 58-67

Lightfoot-Klein, H. Pharaonic Circumcision of Females in the Sudan (1983) 2 Medical Law 253 at 357 quoted in Mason, C., (2001)

Female Circumcision vs Male Circumcision(culture)

(This isn't a finished product yet. I am looking for opinions on this in combination with the first FGM MGM post as well as the conclusion. If you are going to attack me for this blog please read the first blog that compares female and male circumcision. Everyone seems to only equate female circumcision to infibulation which gets people angry at me and just leads to a whole mess of problems previous post
Conclusion )

The more I read my post and comments about female circumcision vs male circumcision, I realized that my first post was grossly inadequate. While I will not apologize for anything I said, I do realize that it was incomplete. The main thing I left out was the culture of each practice. I completely neglected why the procedures were performed. While I would like to deal exclusively with culture, the physical side and the cultural side are not completely separable. I will try to concentrate on the cultural aspects, but a reasonable amount of physical effects will make its way here. Lastly, before I begin, I would like to share two comments about the last blog that I feel are very relevant to this one.

"I am not fond of all of this comparison to assess which genital mutilation is worse than which. We shouldn't need to do it. Unfortunately, it is a pillar of male circumcision supporters that the male and female varieties are completely disconnected. Support of genital integrity for everyone requires disproving that lie when it is asserted."

"That is a good answer to the oft heard comment "you can't compare male vs female circumcision" which, when said, really means: "I want to complain about a barbaric act in another culture without having to own up to my own culture's barbarity. If I looked at male circumcision with a critical eye, I might learn that similar cultural forces are at work but that would be work and it's just so much more fun to not have to think."

I really like how each is phrased. The first gives a very good reason for making this comparison which I would not have formulated on my own. The second focus on the ethnocentrism of Americans. It really is amazing how we as Americans can criticize other cultures without realizing that we are not so very different. In all honesty comparing Male and Female circumcision for which is "worse" is silly. Which is the worse, torture, murder, or rape? Who really cares? They are all disgusting. Anyway, I thought I should share before I get into the comparisons.

In my opinion, one of the most interesting things about female and male circumcision is how similar their histories are. Perhaps the most central argument of most Americans about female circumcision is that it is a procedure of male dominance over women to decrease their sexuality. That is that the entire purpose of a female circumcision is to decrease sexual pleasure for women. This is fascinating as I still haven't heard anyone use this as a reason in a specific case. In all the articles I have read defending female circumcision, the females in the family are the ones supporting it and performing it. (ie (2))(3)(4) There is no mention of sexuality. Rather you usually hear things such as: it is cleaner, it is a rite of passage, it is a part of our culture, you will be like the other girls. It is quite odd that these reasons seem eerily familiar. Now I am not at all dismissing that female circumcision exists to limit sexuality at all. There is truth in that. No doubt it is the origins of the custom for many cultures, and it is still the underlying reason. Despite this, advocates of female circumcision never use this as an argument. Also, while this is relevant to some cultures that perform female circumcision, it by no means covers all of them. What is interesting is that the female circumcision advocates do indeed have evidence that it does in fact help prevent STDs. They didn't make it up as many Westerners would like to believe. (1)(2)

I detail all of the cultural reasons in my History of Circumcision post and in my Culture post so I will not spend to long talking about the male side of the story. The current reasons you know well. Male circumcision is supposed to prevent x diseases. Male circumcision will make you son more comfortable around others. Male circumcision is just what you do. Your suspicion that secular circumcision started as a medical procedure is correct. However, the disease that it cured was masturbation. Circumcision was known to cause pain, difficulty of masturbation, and reduced pleasure. Masturbation and sexual pleasure were seen as evil during the Victorian era and circumcision was used as a treatment for both. This implies that the secular use of circumcision started to perform harm to a male's sexuality.

Now when you look at the two side by side they are so similar that even a blind man can't ignore it. Both originated to curb sexuality and sexual pleasure. Both became a cultural decision rather than a rational one. Both are supported by the victims of the practice. Both are justified by supposed medical benefits. Culturally these procedures developed on a remarkably similar timeline despite having evolved, for the most part, independently.

This is where we diverge a little. Female circumcision does not describe a specific surgery. There are all different levels involved. Infibulation is commonly thought of as the worst, and Sudan can be thought of as the infibulation capital of the world. This actually is one of those cultures that does want to limit female, as well as male promiscuity. Males are merely meant to abstain from sexual contact. Female are intended not to enjoy sex. Women that show sexual arousal and enjoyment are seen to be "animal like." One western team of researchers traveled to Sudan to interview women who had been through the procedure. They would not discuss sexual experiences at all in front of others, but when they were taken aside where they could speak freely, they would often talk about how much sexual pleasure they had, and that they did experience quite fulfilling orgasms. They could not show that they felt pleasure, but based on their glowing faces it was apparent that they did. This led the researchers to conclude that western views of the effects on female circumcision are "grossly exaggerated". Now before all you women jump all over me and call me a misogynistic pig, this entire story is posted on fgmnetwork.org.(5) They do not in any way attack the research. On the contrary they are supporting it.

It is very difficult to compare the to two culturally. Male circumcision has two cultures. You have the religious culture with Jews and Muslims, and you have the secular and pseudo medical procedure performed in the US. The culture behind female circumcision is much more varied. However, as I describe above, all forms of female circumcision have more in common with male circumcision than most Americans would care to admit.


(1) Study on AIDS
(2) Muslim website designed and intended for Women
(3) Women wanting a circumcision
(4) New York Times
(5) FGM network

Female Circumcision vs Male Circumcision (conclusion)

As I hope you have read in the previous couple of blogs, male and female circumcision are indeed linked. That is not to say that they are one and the same. They are very similar. They do much of the same things for much of the same reasons. There are obviously many differences. They are performed in different cultures. One is secular one isn't. Male circumcision (other than botches) is at least relatively uniform. Female circumcision has some variety.

One of the obvious comments that comes up with this discussion is "female circumcision is far worse than male circumcision." Well it may or may not be. This is up for debate. However, it really isn't important when you stop and think about it. Is rape ever justified because it is better than murder? Of course not. Why then is one procedure justified because it could have been worse? In other words, it's not a competition. The take home message is that these procedures are linked, not identical. When you look at the cold hard facts you cannot possibly deny it. There is just no getting around it.

Now why do I even post this? American's think very little about other cultures. We are among the worst in the world at judging other cultures by our cultural norms while we remain oblivious to the similarities. Think on a bigger scale. What are the driving forces at work here? Why are we in the situations that we are in? How different are we really?

Circumcision and UTIs

Well that last post sure stirred some things up. I doubt these will do the same but we shall see. Next I am going to tackle the reasons to circumcise. I will only concentrate on the ones commonly used today, becuase going over all of them will take the rest of my life. The first thing I am going to do is concentrate on the medical reasons to circumcise. I will post these from most absurd to, well kinda sorta. Next I will talk about the cultural reasons to circumcise. First up, obviously, is UTIs.

This is one of the less touted benefits of circumcision, but it is still worth addressing. Many claim that circumcision in males lowers the risk of urinary tract infections, or UTIs. One problem in defending against this claim, is that proponents of circumcision cannot agree on what exactly circumcision does for UTIs. Many studies seem to indicate that circumcised males are less likely to get a UTI but only in their first year of life. Other studies claim that the odds are reduced for the circumcised male's entire life. One study even found that Jewish circumcision performed by mohels actually increased the odds of UTIs. (1)(2)

UTIs are much more common in females than males. A typical female can expect to have one UTIs in her lifetime statistically speaking. Roughly one in one-hundred males will ever experience a UTI whether circumcised or uncircumcised.(*) When anyone gets a UTI they usually take this neat new pill called an antibiotic. As a UTI is a bacterial infection, antibiotics work wonders. Doctors are supposed to perform the least invasive, effective treatment which mean that pills > surgery. I hate to be so unbalanced on this, but performing surgery to prevent a rare, minor, easily treated condition is silly. First off, you are preventing something that the vast majority of people will not get. 2nd, even if they do get it, it really isn't a big deal. Pop some pills, and everything will return to normal in a few days.

(1)Prais D, Shoov-Furman R, & Amir J. Is ritual circumcision a risk factor for neonatal urinary tract infections? Arch. Dis. Child. published online 6 Oct 2008.

(2) article about Jewish Circumcision and UTIs

(*) Like any other statistic, different sources quote different numbers. The general concept that females are much more likely than men to get a UTI is the same.

Circumcision is Cleaner

This is the argument used mostly by the uneducated. They don't know specifically what circumcision helps, so they just say it's generically cleaner. Most anti-circumcision advocates will dispute this and say that you can easily keep it clean by yourself. Well they are both right. If you cut something, it is going to be cleaner. There is no denying that. However, if you use this logic and really apply it, we would all just be torsos with heads.

Many people maintain that the foreskin is "dirty." This is again mostly uneducated people. Generally speaking, doctors don't argue this. The foreskin is no dirtier than any other skin that is cleaned. The main theory behind the foreskin being dirty is that the area between the foreskin and the glans is warm and moist. That is a good breeding ground for germs. The main argument against this comes from a well known quote from Doctor Dean Edell. He says, "If a foreskin is dirty, than a vagina is dirtier. If cleanliness is a good reason to circumcise males, than we have a better reason to circumcise females. Water is the solution"

In reality circumcision for ease of cleaning is more of a symptom of culture than medicine. Many women today think of a foreskin and immediately think "ew gross," in the same way that many men in Africa will see an intact female and think the same thing. Both are based in culture rather than reality. Assuming proper hygiene is maintained, cleanliness is a non-issue in both males and females. As we trust females to clean themselves, it shouldn't to too hard to extend the same trust to males, especially considering cleaning a female is much harder than cleaning a male.

Circumcision Cures Cancer!!!

Penile Cancer and Cervical Cancer are just what they sound like, cancer of the penis and cervix respectively. Circumcision has long been used to prevent cancer, yet there is almost zero evidence to support it. The rate of penile cancer in the United States is much higher than in Europe, which is mostly intact. For various years between 1966 and 1972, the annual rate of new cases of penile cancer was 0.8 for the United States (which circumcises), and 0.5 for Finland, 0.9 for Denmark and 1.1 for both Norway and Sweden (all of which do not). None of these differences are statistically significant. Further, within the same time frame, both France and the United States had the same rate, 0.3, of deaths due to penile cancer. Many 3rd world countries that have a large percentage of their population circumcised have a huge risk of developing penile cancer.(2)(3) Conclusion: Cleanliness not Circumcision prevents penile cancer.

The notion that circumcision in any way prevents cancer has been completely dismissed. Circumcision was used to prevent cancer because smegma was believed to be a carcinogen. (4) This claim was supported by a very old study that took the circumcision status of males as well as their penile cancer status. A much greater percentage of intact males had penile cancer. Eureka! Circumcision cures cancer! Well actually it turns out that most of the elderly were intact at the time and penile cancer is an old man's disease. When a greater percentage of circumcised males reached old age they got penile cancer in similar numbers as the previous generation. Anyway, back to smegma. There have only ever been two studies regarding smegma and both have found it to be completely harmless. This is very fortunate for women as they produce several times the amount that men do.

Up until recently the AAP claimed that circumcision did prevent penile and cervical cancer. The American Cancer Society reprimanded them with a letter. This isn't some no name organization filing a complaint. This is the American Cancer Society.

Dear Dr. Rappo:

As representatives of the American Cancer Society, we would like to discourage the American Academy of Pediatrics from promoting routine circumcision as a preventive measure for penile or cervical cancer. The American Cancer Society does not consider routine circumcision to be a valid or effective measure to prevent such cancers.

Research suggesting a pattern in the circumcision status of partners of women with cervical cancer is methodologically flawed, outdated, and has not been taken seriously in the medical community for decades.

Likewise, research claiming a relationship between circumcision and penile cancer is inconclusive. Penile cancer is an extremely rare condition, affecting one in 200,000 men in the United States. Penile cancer rates in countries which do not practice circumcision are lower than those found in the United States. Fatalities caused by circumcision accidents may approximate the mortality rate from penile cancer.

Portraying routine circumcision as an effective means of prevention distracts the public from the task of avoiding the behaviors proven to contribute to penile and cervical cancer: especially cigarette smoking, and unprotected sexual relations with multiple partners. Perpetuating the mistaken belief that circumcision prevents cancer is inappropriate.

Sincerely,

(signed)
Hugh Shingleton, M.D.
National Vice President Detection & Treatment

The ACS reaffirmed their position in 2006 stating that penile cancer is a very rare disease and circumcision is not a valid procedure to prevent it.(1) Simply put, circumcision to prevent cancer is completely false and a myth.

Another interesting thing about the cancer argument is that men are much more likely to develop breast cancer than penile cancer. If the goal was to prevent cancer, the removal of the breasts is a much more medically sound procedure. However, this procedure was not widespread at the time, circumcision was. Conclusion: The solution circumcision was invented before there was a problem for it to treat.

(1) 2006 Penile Cancer

(2) Hyman AB; Brownstein MH. Tyson's "Glands," Archives of Dermatology, vol. 99, no. 1 (January 1969): pp. 31-37.
(3) http://www.cirp.org/library/disease/cancer/
(4) Wolbarst A. Circumcision and Penile Cancer. The Lancet, vol. 1 no. 5655 (January 16, 1932): pp. 150-153.

Circumcision and AIDs/STDs

For the purposes of this blog I will only be talking about AIDs. The information available about other STDs as they pertain to circumcision is very limited. Also, the debate about whether or not circumcision should be mandatory is largely due to AIDs. Throughout the last 30 years of the twentieth century, medical associations all over the world were in agreement that there is no medical reason to circumcise. Almost all medical associations still believe this to be true. However there is a new study done that has opened the debate once more. Just do a simple search of circumcision on the WHO's website. You won't see anything about cancer, UTIs, phimosis, or other STDs. All they talk about is the heterosexual acquisition of AIDs.

There were three major studies done in the past decade to determine the effect of circumcision on HIV. The studies finished early due to the success, and resulted in a relative risk reduction of 53% 55% and 60%. The first reaction is to say, SWEET!!! Circumcision can be used to prevent AIDS. Everyone should be circumcised. Well like everything else in life its a little more complicated than that.

First it is important to know what this study says and what it does not say. This study makes the assertion that circumcision can prevent HIV acquisition of males who engage in heterosexual sex. There is zero evidence that circumcision protects women in any way, or men who engage in homosexual sex.

While the relative risk of circumcision looks to be beneficial on that scale, it hasn't worked out that way in large countries. The first row is a list of countries with the percentage of adults living with AIDS. The 2nd row is other countries where most of the population is intact with the rates of AIDs. (3) Information from CIA world factbook.

United States 0.6% Iran 0.2% Israel 0.1% Saudi Arabia 0.1% UAE 0.2%

Germany 0.1% Chile 0.3% U.K. 0.2% Australia 0.2% China 0.1%

As you can see, there isn't a lot of difference. With the exception of the United States, the uncircumcised figures are slightly above the circumcised countries. However, the circumcised countries tend to be the most sexually conservative societies on earth. Furthermore, with the exception of the United States, all countries that circumcise more than half of the men are almost entirely Muslim or Jewish.

Another aspect to consider is the reality of AIDS outside of Africa. In Western cultures, AIDs is mostly a phenomenon of gay men and drug users. In 2006 in Australia there were 854 new HIV diagnoses for men, of which only 77 (9 percent) were for men who were infected through sex with women. (1) In the United States only 11 percent of those diagnosed with AIDS were in men who had contracted HIV through sex with women.(4) This is significant because even if these studies are accurate, circumcision would only help to protect roughly 10% of those who are at risk of becoming HIV positive. As the relative risk was quoted at 60%, only 6% of those who are at risk would be protected. As the study covered a time span of less than two years, the percentage of those protected becomes less and less until it is statistically insignificant.

Alright, so something has gone seriously wrong. This study that was supposed to be this great cure for AIDS really isn't working very well. Even in the United States where historically the vast majority of males have been circumcised, the rate of AIDS in still abnormally high. In fact, the United States has the highest rate of AIDS in the world with the exception of Africa.

Let's go back and take a closer look at these studies. Oddly enough, the only place I have been able to find the raw data is from an anti circumcision site. You would think that the pro circumcision sites with be parading the raw figures around as this is their main argument. This blog isn't very friendly to big tables so the table can be found near the bottom of this page. The first thing that stands out to me is out of 11,000 people tested, only 73 were "protected" from HIV. The reason for this is the number quoted is the relative risk reduction, not the total risk reduction. 2.49% of the control group became HIV positive during the test. 1.18% of the circumcised males became HIV positive during the test. This resulted in an absolute risk reduction of 1.8%.

The most famous study was conducted by Auvert. This is the one that found the 60% relative risk. In his study conducted over 21 months, 49 circumcised males and 20 intact males contracted HIV. In theory, 29 people were protected. Using this study, Auvert concluded that he could prevent "(1.1−3.8) million new HIV infections and 0.3 (0.1−0.5) million deaths over the next ten years in sub-Saharan Africa." (5) So as a result of 29 people not getting HIV, partially due to abstinence, you can extrapolate to prevent half a million deaths? I'm not buying it.

One of the major problems with this test it some of the testing procedures used were flawed. For the first several months the circumcised group was instructed to abstain from sexual activity while they healed, giving the intact group a head start in getting infected. After several months the rates of infection were becoming closer. Suddenly when the rates stabilized, the study was called off early. (6) Another aspect to consider is that the HIV test doesn't check for the HIV virus. It checks for antibodies for the HIV virus, which can take months for your body to produce. If one member circumcised group waited 3 months to heal, and became infected 2 months later, the test would not come back with a positive result until one full year after the study started. A study in New Zealand simply took a sample of males born between 1972 and 1973 and tested them for STDs. They found no statistical difference between circumcised and intact males whether or not they adjusted for socioeconomic status and sexual behavior. (7) This supports the claim that circumcision is probably not beneficial in the long term.



(1) John Murray, Circumcision no barrier to HIV, "The Australian"

(2) Circumcision and risk of sexually transmitted infections in a birth cohort

(3) CIA world factbook

(4) CDC.gov

(5) findings

(6) See table in the other blog or here.

(7) New Zealand study

Phimosis

Yet another reason given for circumcising your son is Phimosis. Phimosis is a condition in which the foreskin sticks to the glans and cannot retract. Circumcision actually does treat Phimosis. If you cut the foreksin off it won't stick to the glans. (Well most of the time, but now we are just splitting hairs)

Well I am going to be honest with this. It is a very hard topic to blog on. When it comes to phimosis everyone is different when it comes to what is normal. It is really something that needs to be done on a case by case basis. For this reason I am not even going to bother with the citations and just use ubiquitous knowledge.

Most of the people who are circumcised becuase of phimosis are circumcised at an early age. They are typically diagnosed with childhood phimosis. The problem is childhood phimosis, as doctors usually diagnose it, doesn't exist. That is the way males are born. The foreskin is usually unable to retract until age 1 at the earliest and can be as late as age 13. If the foreskin is able to retract before that it usually means that someone forced it, which is potentially dangerous as it can lead to infections. The reason that this happens is not a conspiracy theory. It is simply an ignorance from American doctors because the last time a majority of males were intact was before WWII. American doctors simply don't know how to deal with a male that has not been cut at birth.

To put it in another way, the skin bonds to the glans in almost the exact same way that your fingernail bonds with your finger. It stays this way for quite awhile. The time frame varies from person to person, but it is not a problem unless it persists until puberty. I don't think you have ever had a doctor that wanted to remove your fingernail simply becuase it could not detach from your finger. If your doctor has done that, you should probably find a different doctor.

Another obvious point this bring up is cleaning. You don't force your fingernail open to clean underneath. Neither should you force your babies foreskin back to clean underneath. Don't get me wrong, after the skin is able to retract, cleaning is necessary, but until that time, if he doesn't retract it, you don't retract it.

Now that we have gotten past that, lets talk about real phimosis. Like pretty much all disorders that circumcision is supposed to cure, phimosis is pretty uncommon as less than 1% of males will ever have it. If you are so unfortunate, steroid creams and stretching techniques are usually very effective in a short amount of time. If it doesn't work there are other less drastic methods available that essentially pry the foreskin off the glans. Normally this is incredibly unhealthy, but if the body doesn't do so on its own its needs to retract at some point. The last method is effective almost 100% of the time, which would make circumcision to treat phimosis silly as it is a much more radical procedure.

If it helps you get the concept better, think about getting your teeth pulled because you have a cavity. The only thing that makes circumcision to treat phimosis more credible is phimosis is the only thing that circumcision actually treats. For everything else you are just trying to prevent something. Everything else is like having your teeth pulled to prevent the cavity. For phimosis you are actually treating cavity, (to go along with the analogy)even though it is a bit of an overreaction.

Another condition that gets thrown into the this category is one where the skin at the urethra is too narrow to allow urine to pass through. Sometimes stretching and, small cuts are used. Often doctors remove the entire foreskin. This is one that makes zero sense to me. You have an opening that is 1 mm in diameter. You need it to be 5mm in diameter. In order to achieve this we are going to cut off 15 square inches of skin. What? Who came up with this logic? Why don't you simple perform stretching techniques, or cut off a small portion of skin to allow urine to pass? Its the bureaucratic mentality I swear. (insert sarcasm) Oh well. I say again, All of these conditions are very rare.

Medical Benefits of Circumcision

If you haven't read the blogs breaking down all of the benefits, read those before you read/comment on this. (Well unless you are just in it for the cliffs notes.)

After a careful review of all of the medical benefits, the case for circumcision is rather poor. There isn't clear evidence than circumcision significantly impacts any of the disorders that it is supposed to treat for. Also, the odds that a male gets any of these disorders is less than 1% - 2%.

Oddly enough the rate of complication tends to be quoted between 1-3%, depending on what you count as a complication. Some people who quote extreme pain and other stress placed on the newborn place the complication rate at 50-75%. Either way, circumcising for medical benefit doesn't seem medically valid.

The most convincing benefit seems to be the prevention of AIDS. I broke this down earlier to show that the benefit was minimal at best, and non-existent at worst, but let's just assume that the studies are 100% accurate. Your newborn isn't going to get AIDS through sex. If your reason to circumcise is for your baby not to get AIDS, than he can make that decision for himself. If he is old enough to consent to sex, he can consent to a circumcision.

The main point, is circumcision for medicine is silly. It really doesn't make sense when you break down all the proposed benefits, and plot out what really happens. I hate to tell all of the mothers this, but the circumcision performed on your son doesn't do him any more good than the procedure used to remove his tonsils. The only three things I can see where circumcision is justified is frostbite, gangrene, and cancer.

Culture

Before this post I have mostly tried to just stick to the facts and not get into too emotional topics. I have no choice but to make this post subjective given the topic. Now, ONWARD!!!!

Circumcision has been so successfully ingrained in our culture, we typically don't think about it anymore. It is even a taboo topic of conversation making the questioning of this practice even harder. As a result, circumcision is no longer a logical decision anymore. It is simply, "Oh its a boy. Circumcise him like everyone else." Given the information I already posted about the benefits of an intact foreskin, the less than substantial evidence of medical benefits, and the actual pain of the procedure, this thinking should be all but gone. However, some cultural concerns still remain.

One popular reason to circumcise babies is so they will match their father. I have even read several blogs on WebMD that recommend that parents make the son match the father. The theory is that the boy will be traumatized if he ever sees his circumcised father naked. If parents believed this, I could see how they would want this done as quickly as possible. The only problem is that this reason is nonsense if you think about it. So when exactly will father and son sit around naked comparing penises? And shouldn't you be worried if your girlfriend told you "wow! You look just like your dad!"?. In all seriousness, a child's genitals looks nothing like an adult's genitals. Another hole in this argument is that most children rarely if ever see their parents naked anyway. It is actually the parents that see the child's genitals all the time during changing and bathing. Maybe making the boy match the father is more for the father than the boy?

Another similar reason to circumcise a son is to avoid awkward situations in the locker room. This is one of my favorite arguments. It goes something like this. "Everyone is doing it so we did it too." Don't you just feel like telling your parents, "Well if everyone was jumping off a bridge would you do that too?" Parents hate it when you justify something by, "Everyone is doing it" yet that is exactly what many parents do themselves. Another reason this argument is silly is your son won't be alone in the locker room anymore. Five years ago the circumcision rate was between 55-60 percent in the United States. This number has been steadily declining over the past several decades. If you use a linear regression analysis, the current circumcision rate is about 50 percent. It is hard to find data about current rates, so 50-55 will have to be close enough. In addition to this, showering in public is becoming rarer and rarer. The vast majority of public showers have curtains.


Some people will not talk about how traumatized their son will be when he sees circumcised men. Instead they just say that the circumcised penis looks better. They did it for cosmetic reasons. I apologize, but this deserves a rant. How sick are you? You performed an extremely painful cosmetic surgery on a newborn so his penis would look better? Do you want your child to turn you on? Really. A parents perception of beauty shouldn't matter when circumcising their son. It is after all his body. Should he not do with it as he sees fit? How do you know that his future wife has the same view of beauty that you do? It is just completely moronic and shallow. Why don't we give all girls breast implants? We want our girls to be attractive to. End rant.

Religion

Alright last but not least is religion. This subject is a lot tougher to deal with. Many Christians feel that they are commanded to circumcise, but if you look closely they clearly are not. (see Circumcision in the Bible) Muslims have adopted this procedure as well even though it is not mentioned in the Koran. Bizarre, but I will give them the benefit of the doubt and say that they are commanded to do it. Jews are the only ones that are clearly commanded to circumcise their males.

Many people are under the belief that if a law ever did pass banning circumcision there would have to be an exception for Jews and Muslims. This is completely false. As long as harm is demonstrated, circumcision can be banned regardless of religion. Freedom of Religion is limited. Many ancient religions practiced human sacrifice. Obviously, human sacrifice is illegal regardless of religion. This is an extreme example but it serves the point. For a closer example, you can look at female circumcision. Female circumcision of a minor is illegal for any reason, including religion. Many Islamic sects require circumcision for the exact same reasons that they require male circumcision. We allow one but not the other.

Religion has been a sticky point in the circumcision debate for quite some time. It is true that many anti-Semites will jump on the anti-circumcision bandwagon to attack the religion. Jews know this, and are understandably against a movement that discourages their commandment and wants to make it illegal.

Personally, my belief is that religion should be ignored in this. Many Rabies will admit than "anyone who does this who is not in the covenant is committing child abuse." That is a direct quote from a Rabi. They know the amount of pain that these babies go through. If we use this logic and outlaw child abuse for all boys, Jews should not be an exception. If indeed circumcision amounts to child abuse than letting Jews continue is letting them get away with child abuse. Why should a Jew be forced to undergo an abusive procedure simply for being born to a Jewish mother? The anti-circ movement has been all about providing boys the same rights that girls enjoy today. Denying that right to Jewish boys would go against everything that the movement stands for.

Many people will see this and say, "If catholic minors can drink win during communion, why can't Jews circumcise?" Well from my point of view, they are only loosely related. The point of alcohol controlling laws is to prevent the abuse of alcohol by minors. For one, many minors do not really know what they are putting into their systems. For two, it takes less alcohol for a minor to get drunk. However, no one is going to get drunk from communion. It just isn't enough alcohol. For two, you aren't going to get yourself into trouble in the middle of mass. For three, in most cases, they are doing this in the presence of their parents. As a result, the purpose of the law is still upheld.

In the circumcision debate, the point is whether or not circumcision is harmful enough to warrant protecting boys as well as girls. If the answer is yes circumcision is harmful, than Jews and Muslims should be just as protected as everyone else.