13 July 2011

More on the Circumcision Debate

I've written before about the circumcision debate as San Francisco decides whether to ban routine infant circumcision.  I thought I'd break down my thoughts on the risk/benefit analysis, bearing in mind that I'm not medically trained.  I'll start by looking at the benefits that are often listed for circumcision.

- decreased risk of UTI.  From the studies I've seen, there does appear to be a decreased risk of UTI with circumcision.  However, the risk of the child contracting a UTI in the first place is rather small, so that over 100 boys would need to be circumcised in order to prevent 1 UTI.  Of those that do contract UTIs, very few will be serious.  I've seen some debate about whether the increased risk of UTI is more about lack of breastfeeding (which protects against UTI) and premature, forceful retraction of the foreskin, since the foreskin protects against infection when left alone.  It therefore seems like a miniscule risk of UTI, so I don't see circumcision as a necessity for that.

- HIV and other STDs.  There are conflicting data on whether circumcision decreases a man's odds of contracting HIV and other STDs.  Even if it does, though, abstinence and monogamy remain the only surefire ways of avoiding these diseases.  Abstinence and monogamy don't require anything to be done to the infant boy, either.  Once again, I don't see how this justifies a surgical procedure.

- cancer.  It's often noted that penile cancer seems to occur exclusively in uncircumcised men.  There's also information about partners of uncircumcised men having a higher incidence of cervical cancer.  Both penile and cervical cancer are often caused by HPV, a sexually transmitted disease.  Again, abstinence and monogamy are the best protectors.  It's true that I cannot guarantee that my son will follow Church teachings on sexual morality, but neither can I assume that he won't follow them.  I can't see justifying a surgical procedure on the chance that my son might not follow Church teachings, though.

- avoid phimosis and similar issues - Sometimes phimosis is actually caused by premature retraction of the foreskin, done by well-meaning family or medical professionals to clean or examine the penis.  This shouldn't be done.  Proper hygiene also decreases the risks of problems.  Rarely, circumcision will be needed later, but there are usually other treatments to try first.  Also, these issues are not unique to uncircumcised men, though they are rarer in circumcised men.

-hygiene - There seems to be a myth that circumcision allows for better hygiene.  But there isn't any special care needed for uncircumcised boys, and the foreskin should be left alone until it's retractable.  At that point, the boy can clean under the foreskin when bathing, but nothing else is required.  Given that we have access to clean water and modern sanitation, I don't see this as an argument for routine infant circumcision, either.

So just based on the stated benefits of circumcision, I don't see that the benefits are significant enough to justify any action.  So what about any risks?  I've read that risks occur in anywhere from 1-5% of circumcisions; while this number isn't huge, it's something to take into account, especially given that, as far as I am concerned, the benefits of circumcision are not great enough to warrant action.  I do think it's telling that the AAP also states that there's no compelling reason to circumcise, since the benefits don't outweigh the risks.  These are just my thoughts, of course.


  1. We had our son circumcised, and there was a bit of a bleeding issue in the beginning, which of course scared me (being a FTM) out of my wits. Still, though, there is a good chance we would have future sons circumcised, for personal reasons. But maybe not; we'll see.

    I certainly understand and sympathize with the reasons NOT to, and every parent has a right to make that decision. But I don't think it is a procedure that necessitates being outright banned; I think it's a choice parents should be allowed to make for their children.

    I think, instead of banning the procedure, people can form a movement to spread information on why it's not necessary. That has been done well already, at least in this country: whereas virtually ALL boys were circumcised in years past, now I believe in some places it's actually the minority. Already insurance companies don't cover it because it's considered a "cosmetic procedure," so that will often be enough to deter parents from making that decision!

    I think people get angry not because it's life-threatening or even dangerous, but because it's a (perhaps painful) altering medical procedure that is mostly cosmetic at this point, and the child "has no say" in whether or not it's done. Many people make the same complaint about infant Baptism: "the kid should have a right to make that choice for himself!"

    For me, I don't think it should be banned. Maybe discouraged (although many parents are made to feel like bad or even abusive parents if they choose it, so it would have to be done very tactfully) but not outright banned.

  2. Oh, I agree with you on the banning issue. I don't even see how it could be banned without infringing on religious rights for Jews and Muslims. Here, it isn't banned, but the NHS won't pay for it. If someone wants it done, they can find a private doctor or a mohel (and I have a friend who has done just that).

    I know some liken it to infant baptism, and rightly so if done for religious reasons, since baptism is the new circumcision. I don't really think it can be comparable, though, since circumcision is more often done because of the reasons listed above, and because baptism doesn't involve any pain and isn't really an irreversible decision, since we don't lose our free will or anything. I do think that education is the way to go, because I think all the facts should be presented so parents could make truly informed decisions. I feel that way about everything, though - I mean, choose to do it or not, but make sure your choice is made after going over the information and deciding what's best.

    Every day we have to make decisions for our children, and I believe that we make the best decisions we can with the info we have. Some of the decisions I've made, I've found out things later that would've changed that decision. I regret those, but I learn from them and move on. Well, I try to do so, at least. ;-)

  3. I think that you have some good points. At first glance, circumcision (like so many cultural practices that we take for granted) seems like not much of a big deal.

    There are health issues though. It does remove around 20,000 nerve endings and what would become fifteen square inches of tissue. Keep in mind that the clitoris contains roughly 10,000 nerve endings. In infants, the foreskin is completely attached and immobile, more or less like a fingernail. It has to be forcibly ripped away from the penis before the surgery itself. Circumcision basically takes an internal organ and makes it external. The surgery inevitably leaves a scar, and can result in a variety of other side effects (like abnormal curvature) as well.

    It can result in death, although deaths resulting from circumcision often go undocumented. http://www.icgi.org/2010/04/infant-circumcision-causes-100-deaths-each-year-in-us/ and http://www.cirp.org/library/death/

    An anesthetic is often not used as it is too dangerous to anesthetize infants.

    So you’re asking, it’s a routine practice in the US, therefore it must do something good, right? But in the whole world, it’s actually only done on a large scale for non-religious reasons in America. Circumcision is basically unknown in Europe, and the people there are not suffering from disease any more than us. In the US, circumcision is a multi-billion dollar a year industry, and such industries will inevitably try to justify their existence. Circumcision began in the US as a way to cure masturbation. Since then, every generation of doctors has come up with some claim as to the supposed health benefits of the operation: STDs, hygiene, etc. The current one is AIDS, but, if it really prevented the transmission of HIV, then why does the US (where circumcision rates in the 1980s were almost 100%) have one of the highest incidents of HIV infection in the developed world?

    I don’t want to get into the female circumcision issue simply because that deserves another post altogether. I will say that both FGM and male circumcision are often motivated by similar factors: perceived cleanliness, perceived health benefits, tradition (we’ve been doing it forever so why should we stop), and the notion that it somehow “looks better” and will make the individual more appealing to the opposite sex. Both procedures are often advocated (or even performed) by people who have undergone the surgery themselves. Here in the West we would say that a woman who has undergone FGM and who wants it done on her child is misguided by culture and doesn’t know any better. But is it all that different from a father who has been circumcised and wants his son to look like him?

    In short, if we accept bodily integrity as a human right, then circumcision (as performed on unconsenting minors) brings up serious ethical issues.

    I encourage you to consider the following websites:


  4. James,

    Thanks for your comments, and I agree with your points. I don't generally go in for banning things, as I prefer to focus on education, though I realise the two are not mutually exclusive. I'm from the US, and had I not moved to the UK prior to my son being born, I'm certain he would've been circ'd. I'd grown up hearing that circumcision was just what you did, so I really didn't question it until I came to England and realised they didn't routinely circ. That was when I researched it and came to the conclusion that it shouldn't be done routinely, in my opinion.