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Circumcision–separating science from opinion

Last updated on September 7th, 2012 at 12:37 pm

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.

Despite the benefits, would I personally advocate that a parent circumcise their male child? I am not sure, but the medical benefits certainly are clear. Since the risks are nearly nonexistent, especially in a medical setting, there really are no legitimate criticisms even if the circumcision is only for religious or cultural reasons. In many countries (including areas of the USA), parents pierce their daughter’s ears for NO medical benefit, and it induces nearly the exact same amount of pain to the baby, yet we do not hear a huge outcry about ear piercings. We vaccinate children, a fairly painful procedure, and except for a tiny minority of vaccine denialists, we accept that painful treatment for the long-term medical protection of the child.
This decision should be a personal one for the parent because there is no evidence that it causes any harm to the child and there is plenty of evidence that it provides a benefit, even if it’s done for purely religious or cultural reasons. There really are more important medical arguments out there. Like why don’t these people complain about how another group of people won’t vaccinate their children.
Michael Simpson

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