Circumcision–separating science from opinion

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.
The Original Skeptical Raptor
Chief Executive Officer at SkepticalRaptor

Lifetime lover of science, especially biomedical research. Spent years in academics, business development, research, and traveling the world shilling for Big Pharma. I love sports, mostly college basketball and football, hockey, and baseball. I enjoy great food and intelligent conversation. And a delicious morning coffee!


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  • Stephen Frost

    First of all, a comparison is a comparison. It is a strawman argument to argue as if someone is in favour of FGM because they are pro-circ, but not to make a comparison. Grass is green and so is green paint; that is a comparison – it isn’t a strawman or a false equivalence. How valid a particular comparison is, depends on the individual comparison, but your assertion that they are all fallacious is simply incorrect. However, implying people are only against routine circumcision because they hate religion IS a strawman.

    “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.”

    The harm is the pain at the time, whether they remember it or not. Also risks from the procedure and the fact that part of their body is being permanently altered. The benefits are minimal and the much-cited WHO study concerns Africa, not the west, where we have sex ed, condoms and clean water. There are conflicting studies, but the consensus is actually that the benefits are minimal at best. This is only common in the US. We do just fine with our foreskins elsewhere. The Canadian Paediatric Society and The National Health Service (UK) both clearly state on their websites that “the benefits do not outweigh the risks”. You can very easily go to their site and see this. The APA is a case of cultural bias, as is your cherry-picked data. Now you may be circumcised and happy with it, but that doesn’t mean it is right to do it to others. You have no data to suggest men restore their foreskins? I mean, seriously? You call yourself a rational sceptic? You need only perform a quick Google search or even search for groups on Facebook and you’ll find thousands of men who restore their foreskins. I know people who do it and I know anecdotes aren’t evidence, so you can clearly go to these websites and see the equipment and people posting photos of their results and videos of using the equipment. You really didn’t even look and you claim there is no evidence of it.

    Cutting off a body part would reduce problems with that body part, sure. I’m sure cutting off breasts reduces the chances of breast cancer. Hey, earlobes are pretty useless, so perhaps we should cut those off. Although ear piercing is a false equivalence, because it doesn’t result in permanent disfigurement, I happen to also be against the practice of piercing a baby’s ears, FYI. The benefits need not only outweigh the risks (which they do not), they need to do so to enough of an extent to warrant the permanent altering of the child’s penis. This also makes comparing it to vaccination misleading. Vaccinations are also nowhere near as painful as cutting off a foreskin btw.

    Your cherry-picked studies confuse correlation for causation and I notice one even says “borderline statistical significance”. Even the biased APA says that the benefits are not enough for them to recommend routine circumcision of babies, so where do you get this idea about the benefits being great and the risks being small? Your beloved APA disagrees. The CPS and NHS go further in saying that the benefits do not outweigh the risks at all. The science behind this issue is actually very clearly in favour of intactivists, but the skeptical community has been backwards in embracing this truth, because it is largely American men who are in denial about having been forced to have unnecessary genital surgery. Any time I’ve brought it up, there have been angry American men, acting as if I have said their genitals are ugly, evil or inferior. I happen to be a gay man and I’ve been with circumcised guys and had a perfectly great time with them. I’m not against circumcision and I don’t dislike circumcised penises; I’m against routinely performing permanent alterations to a child’s penis when the benefits don’t outweigh the risks, let alone enough to excuse such a permanent change to his body. I like my ear piercings, but I don’t advocate doing it to babies. I like tattoos, but I don’t advocate doing it to babies. In fact, given that the benefits DO NOT outweigh the risks, this permanent alteration is no more excusable than tattooing a baby.
    You can see study showing more American boys get UTIs when they’re uncircumcised (hardly a dangerous condition btw) and what you fail to see is that it’s because American parents and even medical professionals are rarely taught how to properly care for uncircumcised boys. I’ve seen many a horror story about nurses and doctors pulling them back and causing bleeding. The issue is a lack of education, not the foreskin. European countries still have very low rates of UTIs in men. It’s worth remembering we live in a world with antibiotics, PrEP, HPV vaccine, condoms, soap, clean water and all manner of other things that make the already minimal benefits even less significant.

    The real issue at hand is one of personal body autonomy. The same reason most rational sceptics are pro-choice regarding abortion, is why we should be pro-choice regarding circumcision. Babies tend not to be having sex and the supposed benefits can be obtained by condom use and proper hygiene, so there is no reason to do it against their will. Let them wait and have it done when they’re old enough to decide for themselves.

    I spend just as much, if not more, time debating anti-vaccers. It is entirely possible to advocate for more than one thing at a time.

    The only reasoning you’re rationalising this after the fact, is because John Kellogg suggested circumcision (amongst other things, such as painting acid onto a girl’s clitoris) as a way to deter masturbation. He said the pain was an important part of this. Had his quackery not become so mainstream in the US, your country would be like the rest of the western world in not performing the procedure as a matter of routine.

    Of course it would be fallacious to make an appeal to authority, but you should ask yourself whether you truly think the CPS, the NHS, various other national health authorities throughout the world have made a mistake in saying the benefits do not outweigh the risks (and the APA says the benefits aren’t enough to recommend routine circ), but you know better.

  • Kyle

    You really think the American Academy of Pediatrics is “an unbiased and medically-centered group”? Really? You sure about that?

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  • FrederickRhodes

    The general consensus is that the neurological functions of both the masculine and feminine prepuces are for causing and sending sexual arousal signals to the reproductive parts of our brains when physically stimulated, by way of the G spot/ frenular delta nerves, and that the neurological/physiological development and functions of both sexes prepuces can be manipulated/altered during ritual, religious and routine infant/childhood circumcisions and excisions on healthy children, for causing physical and psychological dysfunctions to develop after puberty, without the knowledge of the child or parents. Only proponents of forced ritual circumcision would claim circumcised men don’t complain, and that there is no comparison between male and female circumcision, because they don’t want it to get out that they are using circumcision and excision as population control, religious and racial hygiene, and ethnic cleansing on weak minded superstitious uneducated people. The proponents of ritual circumcision site debunked studies religious paranoia, and inflated benefits as their reasons, of which can also be achieved with a proper sexual health education to prevent causing, needing, or wanting a prepuce excision surgery, and never mention the sexual functions of both sexes prepuces, ignorantly suggesting they are just useless flaps of skin.

  • Well, I can see where the list of “anti-circumcision side” arguments were copy+pasted (and not wholly; there’s a sick joke in that) from: an article from 2008.
    http://www.sciencebasedmedicine.org/circumcision-what-does-science-say/

    Speaking for myself, I would not say “nature makes no mistakes”. The way human populations have been able to intermingle globally and our advances in anti-bacterial medicine have surely changed the game between the evolutionary advances of us and the wee beasties which infect us. Nowadays, vaccination is the lesser of two evils, counter to some souped-up germ that would wreck an unprepared body.

    But see, vaccinations are a forceful expedition of a natural process (introduction of pathogens, formation of antibodies), whereas genital cutting is not an inherent function of our bodies. If it’s then argued that the gonad game has changed, I would contend that even if it has, tissue excision, especially of those incapable of personal consent and to whom the benefits would not apply, is not a suitable measure.

    Reasons (and condoms, apparently) aside, I’d like to tackle at least one point by providing study regarding circumcisional pain resulting in a greater pain response during vaccination: http://www.ncbi.nlm.nih.gov/pubmed/9057731
    (There are undoubtedly more studies and discussions on this relation that you may be more energized to seek than I currently am.)

    By the by, are you a fan of modest proposals? http://www.returnofkings.com/39017/should-we-circumcise-women-to-prevent-throat-cancer-in-men

  • Lawrence Newman

    It’s not a strawman argument. It’s a valid argument. FGM is equal to MGM in that bits of a person’s body are being cut of without their consent and for non-medical reasons. Male ‘circumcision’ has never been nor will ever be a therapeutic medical procedure. It was always an act of sexual suppression. I’m guessing the man writing this was circumcised at birth and has no point of comparison. But I can tell you with 100% certainty that circumcision pretty much destroys sexual pleasure. I’ve experienced both, so I know. The foreskin and frenulum are where pretty much all sexual sensation comes from. This is all documented. And if you don’t believe me, ask an intact man.

    Male circumcision is more sexually damaging than type 2 FGM. But the American medical community are heavily invested in this culturally, emotionally and financially, and are trying to find more post hoc rationalisations to keep the practice alive.

    Anyone who says FGM and MGM aren’t comparable needs to go and boil their head, because they’re just not thinking clearly.

      • JPDL

        It’s antisemitic why? The rules are the same to everyone. They aren’t making different rules for jews specifically, sorry but the anti-semitic accusation is low, they are still free to do it when they consent anyway.

    • Lawrence Newman

      I’m suicidal over being cut at 14. It ruined my life.

      http://www.amazon.com/Unspeakable-Mutilations-Circumcised-Men-Speak/dp/1495266575/ref=sr_1_1?ie=UTF8&qid=1405075864&sr=8-1&keywords=unspeakable+mutilations

      My story is in this book, along with 49 other guys’

      • Anecdotes have no meaning to me.

        • Lawrence Newman

          Not when they debunk your claims. If my anecdote backed up your pro-circ beliefs, you wouldn’t have commented.

          But if you don’t believe me, here’s evidence:

          http://www.prweb.com/releases/2007/03/prweb512999.htm

          http://www.cirp.org/library/anatomy/cold-taylor/

          “The glans penis is primarily innervated by free nerve endings and has primarily protopathic sensitivity [43]. Protopathic sensitivity refers to cruder, poorly localized feelings (including pain, some temperature sensations and certain perceptions of mechanical contact) [44]. In the glans penis, encapsulated end-organs are sparse, and found mainly along the glans corona and the frenulum [43]. The only portion of the body with less fine-touch discrimination than the glans penis is the heel of the foot [45].”

          The foreskin is an organ in its own right and is the primary sexual tissue of the penis. The glans is virtually worthless in terms of sexual sensation, apart from a scattering of light-touch receptors on the corona.

          This is all established stuff. Only an American would deny that the foreskin is primary erogenous tissue. But this is the typical psychopathology of the average American male circumcised from birth–denial and rage.

          Male circumcision was never a medical procedure; it was always done to diminish sexual pleasure. It shares a similar history to FGM in the West–it ‘cures’ masturbation, or at least that was the intention. It is more sexually damaging than type 2 FGM because more sexual tissue is cut off.

          This blog isn’t sceptical, it’s simply reflecting all your physical and emotional issues regarding the fact you were mutilated. Give it 10-20 years and you may end up an intactivist. Ever heard of the stages of grief?

      • Lawrence Newman

        “I think given that the vast majority of circumcisions are safe”

        Circumcision isn’t any safer than FGM. 1) It destroys sexual pleasure because the foreskin is where sexual sensation almost exclusively resides; and 2) Over 100 babies die in the USA every yr alone, and thousands worldwide.

        I can say with 100% certainty that the author of this piece is a man circumcised from birth and who has serious emotional issues because of it. He is trying to reduce his cognitive dissonance. I bet his heart was thumping at a lot higher pace as he wrote this.

        That’s how many circumcised men deal with the trauma.

      • Lawrence Newman

        They used to say it prevented TB. Do you think it prevents TB too?

        There is zero evidence that circumcision reduces HIV contraction risk. One only has to look at the geographical stats on circumcision/HIV rates. The USA has the highest circumcision rate and the highest HIV rate out of all industrialised countries.

        And seeing as you’re so in love with the ‘straw man argument’ line, it’s interesting that you so often strawman. The problem people have with circumcision is that it’s being forced on a baby without his consent. Babies do not have sex. To do this to a baby for this reason, even if it were proven in the future that HIV risk was reduced, is sinister indeed. Condoms are 99% effective. There is abstinence. WE have no knowledge of how promiscuous or sensible this baby will grow up to be.

        And on top of all that, you’re taking the most sexually sensitive part of the penis away and depriving the baby of a fulfilling sex life in adulthood. He will never experience sex as nature intended it.

        The fundamental problem with the author of this piece is that he’s obviously ignorant about the structure and function of the foreskin.The foreskin is an organ that is the primary site of sexual sensation. American anatomy and physiology books don’t even educate people on the foreskin, because most men were walking about without one. This is slowly changing. In Europe, people are well aware of what the foreskin does. Ask any intact man where his pleasure comes from and he will tell you it’s his foreskin.

        This was meant for Michael Simpson,

      • Lawrence Newman

        You’re in love with this term straw man. I think you don’t realise what it actually means.

        Yes, it is ad hominem, but still worth considering. You have to ask yourself why all these studies done in Africa (because they’d be unethical to do in Western countries) are all done by circumcised pro-circ doctors.

        But yes, we should evaluate the papers. But if you can objectively evaluate scientific papers, you would realise that all of those African trials were methodologically absurd. There is still zero evidence HIV rates reduce with circumcision. It is a post hoc rationalisation. they’re now trying to say it lowers the risk of prostate cancer. It used to prevent tuberculosis and cure epilepsy.

        Peer-review isn’t the stamp of authenticity you think it is. It’s only as good as the level of objectivity of the peers who review it. These trials were peer-reviewed by …. you guessed it ….. pro-circ doctors, some of whom are documented circumfetishists and associates and members of the Gilgal Society.

      • Lawrence Newman

        Ear piercings do not destroy sexual pleasure. They are also reversible, because the holes fill up. Vaccinations are valid medical procedures that confer protection from disease. Circumcision is an ancient Egyptian slavemarking ritual and act of sexual suppression. There is no comparison.

      • Lawrence Newman

        It’s mutilation, by definition, just like FGM is mutilation. .