Circumcision is one topic that certainly brings up more emotion than just about any medical procedure. In fact, the same level of rhetoric is used for and against circumcision that one hears with regards to vaccines, or even abortion. Recently, the city of San Francisco attempted to ban the practice, but a judge ruled that only the state could regulate medical procedures. During the summer, a German court banned circumcision for religious purposes, though a German court banning a Jewish practice must have blown up irony meters across the world.
In any discussion about circumcision, there is general consensus that female circumcision, or female genital mutilation, is an abhorrent non-medical procedure that is simply an anti-female procedure in many male-dominated societies. We’re not talking about that, and any comparison between male and female circumcision is a strawman argument. It is also clear that part of the anti-circumcision argument centers around secularism and atheism, because male circumcision is integral to both the practice ofJudaism and Islam. That is a valid argument, and there could even be a concern that unskilled individuals performing ritual circumcisions could cause serious complications. I personally could care less about religious rituals as long as they don’t harm anyone, so this is where we need to determine what the evidence tell us.
As best as I can tell, here’s what the anti-circumcision side argues:
- “Nature makes no mistakes”–That’s the Naturalistic Fallacy. I guess cancer, autoimmune diseases, polio, etc. were perfectly planned. Besides, “nature” isn’t intelligent, that’s not how evolution works.
- It’s genital mutilation and a violation of human rights–How? Why? If it does no harm (stay tuned) and provides a benefit (stay tuned), then this argument falls apart.
- It’s cruel; babies suffer terrible pain. Babies remember the pain–Absolutely no evidence. The abortion opponents use a similar argument that falls apart.
- Circumcised men don’t get as much pleasure from sex–According to this large review of medical data, “there were no reported differences in sexual satisfaction in the randomized study arms in either the Ugandan or Kenyan male circumcision trials or among men before and after they were circumcised.”
- There are permanent physiologic consequences: boys who were circumcised at birth are more sensitive to pain later in life–Once more, the same study stated, “Serious long-term complications are extremely rare.”
- Circumcised men are psychologically damaged–Again, that report said, “there was no consistent or substantial evidence of change in sexual behavior after circumcision in the Kenyan or Ugandan randomized controlled trials.“
- Some men mourn their lost foreskin; some miss it so much that they try to reconstruct it–No evidence
- A child has no informed consent to the procedure–This is a strawman argument. A child has no informed consent to any medical procedure, because the parent is theoretically supposed to know better. In fact, I would argue that parents who do not vaccinate do not have that right, but I’m not in control of that decision. But children have medical procedures done to them all the time. It’s not a legitimate argument.
(Note: When I say “no evidence”, I mean no secondary evidence published in a peer-reviewed high impact journal, not an anecdotal story told by someone in NaturalNews.)
Of course, on the other side is real science. Recently, the American Academy of Pediatrics, an unbiased and medically-centered group, issued this guideline (detailed Circumcision Policy Statement from same group):
Male circumcision is a common procedure, generally performed during the newborn period in the United States. In 2007, the American Academy of Pediatrics (AAP) formed a multidisciplinary task force of AAP members and other stakeholders to evaluate the recent evidence on male circumcision and update the Academy’s 1999 recommendations in this area. Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedure’s benefits justify access to this procedure for families who choose it. Specific benefits identified included prevention of urinary tract infections, penile cancer, and transmission of some sexually transmitted infections, including HIV. The American College of Obstetricians and Gynecologists has endorsed this statement.
This was not based on emotional arguments. It was not based on religion. It was not based on American cultural beliefs (which is something that a lot of Europeans argue). It was based on clinical evidence.
Importantly, the risks are minimal or almost nonexistent. The largest study, of 354,297 male infants born in Washington State from 1987–1996, noted a complication rate in the 130,475 who were circumcised during their newborn hospital stay of only 0.21% (1 in 476). The benefits are clear.
- Circumcision reduces the transmission of HIV. Strongly supported. Two Cochrane Reviews seem to show early evidence that circumcisions reduce the probability of transmission of HIV in homosexuals, although they awaited more evidence from randomized clinical trials. The studies with heterosexuals “strong evidence that male circumcision prevents men in the general population from acquiring HIV from heterosexual sex.”
- Circumcision prevents penile cancer. Supported. Penile cancer is almost unknown in circumcised men, but the risk is about 1 in 600 in uncircumcised US men. However, the American Cancer Society does not recognize circumcision as a preventative procedure to penile cancer, and there just is no evidence as to why circumcision might prevent the rather deadly cancer. This is a case where correlation does not prove causation. However, a recent meta review of circumcision and penile cancer has concluded that “men circumcised in childhood/adolescence are at substantially reduced risk of invasive penile cancer.”
- Circumcision reduces risk of urinary tract infection. Supported. A meta-review from Cochrane shows that there is an immediate reduction in UTI’s, though the effect may be small.
- Circumcision reduces risk of other sexually transmitted diseases. Herpes simplex virus-2. Male circumcision reduces HSV-2 acquisition. Syphillis. A recent systematic review of male circumcision and ulcerative STI strongly indicates that circumcised men are at lower risk of chancroid and syphilis.