On Circumcision Debate, Studies Cut Both Ways

Why do it?

Without significant benefits over the risks, the question has to be asked, why do it? Routine infant circumcision is surgery of the genitals conducted without the consent of the owner of the genitals. In the US it is illegal to do it to girls, but it is OK for boys?

Many men do not like being circumcised. I practice safe sex. Unfortunately, I don't get to enjoy sex with my fully intact genitals because I was circumcised at birth. I have begun restoring my foreskin (see http://www.RestoringForeskin.org ) and can only wonder how much better an intact foreskin would be compared to my restored foreskin. I know my restored foreskin gives me and my wife much more pleasure than my pre-restoration circumcised penis.

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Bill Bartmann

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Bill Bartmann

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Genital Warts (HPV) in the US

Results of the 1999 to 2004 United States National Health and Nutrition Examination Survey demonstrated that more circumcised men reported having been diagnosed with genital warts compared with uncircumcised men (4.5% and 2.4%, respectively).

That means in the US men are 53% more likely to have genital warts if they ARE circumcised.

http://www.webmd.com/sexual-conditions/hpv-genital-warts/news/20080403/thwart-genital-warts-dont-sleep-around

Should parents amputate sexual tissue from their children?

My interest in this topic is driven by the neonatal circumcision damage done to my penis. As a teenager my penis would tear and bleed during erections, and I would cry from the pain of my testicles being pulled. My father took me to a doctor in Lexington, who basically shrugged and scowled at me. His advice: just live with it.

A hundred years ago U.S. circumcisers, with great medical authority, assured parents that the intended sexual damage from circumcision - of boys and girls - was morally beneficial. Today circumcisers are frantically trying to assure parents of the absurd notion that amputation of sexually sensitive tissue from boys does not affect sexual sensation or function, while no medical association recommends neonatal circumcision, and few intact adult males need this surgery, either for medical or psychological reasons. What then are the motives of doctors who offer to amputate - the word used by the American Academy of Pediatrics in their medical description of circumcision - sexual tissue from non-consenting minors? What rights are boys missing that allows adults to strap them down and cut off perfectly healthy, normal, sexual tissue, while the same thing done to an adult - or a girl - is considered a felony?

I could never figure out what caused that wretched ring of scar tissue, and I couldn't imagine just what circumcision had cut off, until I shared a room with another student at a scientific meeting in Hong Kong, where I presented some research on polar motion. There, I got a fleeting glimpse of a man with a whole penis. I couldn't believe it: where was the scar tissue? What was that neat glove of unblemished skin that hid his glans? Why wasn't there hair on the shaft? Pathetic: at the age of 35 I finally figured out what was done to me.

But I don't think I was particularly clueless: in circumcised America, I bet most men don't know that they are missing about 15 square inches of skin and mucosal tissue that is an integral part of the penis. Ironically for women who support male circumcision, the clitoral hood, clitoris, and labia were once targeted by American doctors using similar excuses they now give for cutting males. I also don't think that my poorly done circumcision - as if there could be a good way of amputating part of a babies' penis - is that rare, if the complications rates touted by the medical profession are correct. At the very least, there must be thousands of men in the U.S. suffering from what could only be described as genital mutilation. How could that happen in the U.S., with all our glorious talk about freedom and justice for all?

Circumcision is now in the news a lot because it appears that sexually promiscuous African men, when circumcised, get HIV from infected women at about half the rate of their countrymen with a whole penis, and amazingly circumcisers have pounced on this as another reason to continue the cutting of baby boys in the U.S. But in the end there is no proven medical reason for cutting off the foreskin, which is why no medical association in the U.S. or anywhere recommends neonatal circumcision.

I feel cheated and robbed. I had no choice, there was no benefit, and the risks were realized with a dark, purplish ring of scar tissue where nature had once placed part of my penis. With most of the shaft skin amputated, every erection is an uncomfortable reminder of that smirking doctor I saw as a teenager. Forced genital cutting is a cultural disease, passed on from one mutilated generation to the next, that has no place in a free society.

If circumcision wasn't tied so closely to religion, there is little doubt it would have been outlawed years ago. There have been several attempts to severely restrict or out right ban circumcision in some European countries, where a secular practice has never existed. As recently as the fall and winter of 2007, the last two Australian states Victoria[1] and South Australia[2] have discontinued public funding for circumcision (Not that it is common in Australia anymore anyway) and the Tasmanian Children's Commissioner, Paul Mason, received the support of the Australian Medical Association to ban non-medically necessary and non-religious circumcision this December[3]. Hopefully, Mr. Mason will succeed his press release can be read here[4].

This close tie to religious tradition, and the fact that it has been common in the US, has also severely restrict appropriate criticism of this issue and few are willing to stand up for what is ethically right. Instead we get a never ending search for justification of something that is essentially a cosmetic procedure. Of the few countries that picked up circumcision, the US remains the only country that continues to routinely perform it. It seems Americans in particular have difficulty realizing that something we have been doing to our children routinely for the better part of 100 years may have not been in their best interest. This is in part why new studies are "up-sold" as we continue to grope for justification. It is important that people know that most claims are false, misleading, or provide a 'benefit' that it is either so far down in the noise it is not worth it or there are far less invasive and more reasonable ways to obtain those benefits.

The Canadian medical ethicists, Dr. Margaret Somerville[5], perhaps said it best: "A common error made by those who want to justify infant male circumcision on the basis of medical benefits is that they believe that as long as some such benefits are present, circumcision can be justified as therapeutic, in the sense of preventive health care. This is not correct. A medical-benefits or "therapeutic" justification requires that:

1. The overall the medical benefits should outweigh the risks and harms of the procedure required to obtain them.

2. That this procedure is the only reasonable way to obtain these benefits.

3. That these benefits are necessary to the well-being of the child.

None of these conditions is fulfilled for routine infant male circumcision."

The pro ported benefits are either a myth or very marginal; any of which can be provided in far less invasive and more effective ways should the need, if ever, arise. Infant circumcision (for non-religious reasons) is very rare outside the US. In Finland, for example, a boy has essentially a 0% change of being circumcised at birth and less than a 1 in 20,000 chance of requiring one later. It is clearly not essential to the welfare of a baby boy.

If an adult, on the other hand, sees some value in circumcision and want to get circumcised that is his choice. And by following that simple concept all the ethical problems are nicely dealt with. There is no immediate need to circumcise boys; they therefore deserve the respect of making that choice for themselves. We protect girls don't boys deserve equal protection?

[1] http://www.smh.com.au/news/national/victoria-cuts-public-hospital-circumcision/2007/08/12/1186857324369.html

[2] http://www.news.com.au/story/0,23599,22741465-421,00.html

[3] href="http://www.abc.net.au/news/stories/2007/12/09/2113665.htm

[4] http://www.circumstitions.com/Rights.html

[5] http://www.intact.ca/canary.htm

Risks mimimized

Absent in the circumcision discussion is an analysis of the damage that often occurs due to operator negligence. Shaft stripping is a real risk no matter what the technique. Often too much shaft skin is taken off and too much inner foreskin is left, which results in a buried penis that must be corrected surgically with less than optimal cosmetic results. A pediatric urologist recently gave a recorded statement in one of my legal cases in which he said that he does one such repair a week! Cutting off a portion of the glans (end of the penis) is not as rare as the medical profession would have parents believe. I am handling three such cases at the moment. Taking off too much shaft skin and pulling the scrotum onto the shaft, often burying the penis, occurs with unfortunate regularity, I believe, in adult circumcisions done with the "sleeve" technique. If the penis is buried and the erection is shortened a skin graft is necessary, is often not very successful, and can never make the penis be the way it was before. I have three such cases pending. In short, there are real risks. (I have not even discussed meatal stenosis (narrowing of the urinary opening, which generally effects only circumcised boys), nor the common cases in which a stripped shaft is allowed to granulate in, resulting in very tight, if not painful, erections, in adulthood). Parents should remember the old adage: "Minor sugery is what is done to you, major surgery is what is done to me." There is no legitimate medical reason to put your son at risk for such serious damage. Just say not to circumcision.

"10 Ways Male Circumcision Hurts Women"

http://www.sexasnatureintendedit.com/ 80% of the world's men enjoy life with a foreskin and have since the beginning of time. In 1980, the Australian equivalent of the AAP said circumcision serves no benefit, the circ rate plunged. But why has it taken so long to get it down to even 55% (a great number, don't get me wrong, but there's *always* room for improvement!) national average? The national average in Canada is 10%. More needs to be done.