It’s proposed as a public health measure, but it’s just another weak rationalization. Ali A. Rizvi breaks down the reasons why.
Circumcision enthusiast Brian J. Morris seems to be very fond of analogies.
In his latest publication in Mayo Clinic Proceedings, he compares male circumcision—the only surgical procedure routinely performed on healthy, non-consenting newborns without any medical indication—to vaccination.
The argument Morris (who is not a pediatrician and does not hold a medical degree) makes is this: The benefits of circumcision are so great that they outnumber the risks by 100 to 1. Therefore, routine circumcision should be made compulsory for all. Hear him say it himself.
His position contradicts the official policy statements of every major medical organization in the developed world, none of which recommend universal newborn circumcision.
In 2012, the American Academy of Pediatrics (AAP) became the only one of these organizations to state that the benefits of newborn circumcision outweigh the risks. However, they still maintained that, “the benefits are not great enough to recommend universal newborn circumcision,” and the decision should be, “left to parents to make in the context of their religious, ethical, and cultural beliefs.”
(Note: This isn’t the first time this organization has based its recommendations on non-science factors. In 2010—to the shock of the larger medical community and pretty much everyone else—the AAP officially endorsed a form of female circumcision. Fortunately, a massive backlash forced them to retract their statement a few months later.)
The AAP’s controversial statement in 2012 also drew a response from a large group of European pediatricians (in Pediatrics, the official journal of the AAP), who accused the organization of “cultural bias.”
I won’t go into the pros and cons of the procedure or the well-documented problems with the African HIV prevention studies, because I’ve written about them previously.
But it does bear repeating that only 30 percent of the world’s men are circumcised. In places like Europe and China, where the prevalence of HIV/AIDS is relatively low, less than 20 percent of males are circumcised. The United States, in contrast, has the highest prevalence of HIV/AIDS in the industrialized world, and also one of the largest populations of circumcised males.
But why entertain the complexities and nuances of the big picture when you can dumb it down to a simple analogy?
In an eyeroll-inducing display of childlike playground antics, Dr. Morris lumps all of the conscientious opposers of circumcision—who value the ethical importance of informed consent and an actual medical indication prior to performing a mutilatory surgical procedure on the genitals of completely healthy babies just to prevent infections that might happen—in the same category as anti-vaxxers.
And this group of anti-child health monsters includes every major pediatric organization in the world.
Here’s the problem. Even if circumcising baby boys had all of the benefits that Morris lauds (including, amazingly, the prevention of “zipper injury” and “bathroom splatter”), it still isn’t the right thing to do.
To explain this, let’s use an analogy that actually works. Allow me to propose, for argument’s sake, the following:
All healthy women should have both breasts removed after menopause to prevent breast cancer.
Does that sound outrageous? Good. Then you might be getting the point already. Here’s why this analogy makes perfect sense:
1. Breast cancer is deadlier and much more common than any foreskin-related condition.
Dr. Morris wants mandatory circumcision of baby boys to prevent conditions that haven’t happened yet, and may never happen. The most life-threatening of these are HIV and penile cancer.
Breast cancer, on the other hand, will affect one in eight women during their lifetime. It is the most common cancer in women, and the second leading cause of cancer death.
Breast cancer is more prevalent than HIV and penile cancer combined, several times over. Removing both breasts after menopause would prevent devastating illness and mortality on a scale that removing the foreskin couldn’t hope to.
2. The breasts have no physiological function after menopause.
Before menopause, breasts have just one primary function—to produce milk for breastfeeding. After menopause, breasts have no physiological function at all, yet still carry a higher risk of cancer development than ever. The incidence of breast cancer increases with age, with a median age of 61 at diagnosis, and 95% of new cases diagnosed in women aged 40 or older.
The foreskin has mechanical and physiological functions throughout sexual and reproductive life. It comprises about 35% of the total penile skin and all the nerve endings that come with it. It protects the glans (head of penis) from keratinization (becoming covered with skin), keeping it moist and sensitive. Its “gliding action” helps reduce vaginal dryness and friction irritation.
Is the foreskin “needed”? No. And neither are the breasts. But it serves its functions for many more years than breasts do, and holds a much lower risk of any life-threatening disease in comparison.
3. Adult women can decide to have their breasts removed. They have autonomy and can provide informed consent.
Newborn baby boys can’t. The decision to surgically alter their genitals—irreversibly, without any medical indication—is not made by them.
If Dr. Morris had recommended voluntary circumcision for adult men who wish to reduce their risks of HIV, penile cancer, or other conditions (remember bathroom ‘splatter’), I would have no problems.
But to perform this procedure routinely on healthy babies is so obviously unethical that I wonder if this would even be a controversy if it didn’t have religion endorsing it.
4. Removing breasts prevents breast cancer just as well as removing foreskins prevents foreskin disorders.
“Circumcision prevents conditions like phimosis,” says Dr. Morris. And he’s right.
Phimosis is a foreskin that is too tight. So what Dr. Morris is saying is this:
“If you don’t have a foreskin, you won’t have a foreskin that is too tight.”
Now, if that kind of logic could be applied to every non-essential appendage on our bodies, preventive medicine would undergo a revolution. Let’s look at this in the context of our analogy.
If you didn’t have breasts, you wouldn’t get breast cancer. If you didn’t have a foreskin, you wouldn’t get phimosis.
So which of the two should we prioritize preventing? The second leading cause of cancer death in women? Or the too-tight foreskin which in the majority of cases will resolve itself without any surgical intervention?
Let’s go for the foreskin! In completely healthy newborns. Without their consent.
5. Surgery to prevent possible infection or encourage hygiene seems to be okay, as long as it’s on infants.
This bears repeating:
Surgery is not the way to confer hygiene in normal, healthy kids. Surgery is not the way to prevent infections in normal, healthy kids.
It is true that uncircumcised baby boys do have a higher chance of getting urinary tract infections (UTI) in the first three months of life. (In baby girls, it’s even more common, but unless you’re the American Academy of Pediatrics for a few months in 2010, circumcision in this demographic is strongly discouraged.)
The way to prevent UTI is hygiene and cleanliness. And the way to treat it is antibiotics. Repeated and/or persistent UTI in baby boys can justify circumcision, and this is not widely disputed. But these infections aren’t even remotely common enough to mandate universal circumcision for all newborns just to prevent them.
Tonsillitis is another common childhood infection, and the tonsils are even more useless than the foreskin. The approach to treating tonsillitis is relatively straightforward. If there’s a life-threatening condition like blockage of the airway, remove them. If there are repeated or chronic infections, remove them. But if it doesn’t get to that point (most cases don’t), treat with medicine like antibiotics. And if there’s nothing wrong with them? Don’t do anything. Leave them alone.
Let’s get back to our breast analogy. Forget hygiene issues and infections — even malignant cancer often doesn’t require complete removal of a breast, much less prevention. And there is no known equivalent of the BRCA1/2 mutations in healthy newborns that predisposes them to penile cancer or any other analogous condition.
So, should we mandate mastectomies? Obviously not; the suggestion is outrageous, and deliberately so. The point is that this outrageous notion is actually more defensible than the proposal to mandate circumcision.
For 3000 years, circumcision has been a cure looking for a disease.
During this time, it has been used in medical practice to prevent hernia, epilepsy, insanity, paralysis, headache, lazy eye, misaligned eyes (strabismus), masturbation, prolapsed rectum, hydrocephalus, club feet, asthma, gout, and bed-wetting.
Today, it’s all about HIV prevention, which is kind of strange.
Think about it. If you want to prevent HIV, an easier, reversible, and much more effective method is the use of condoms. Now, once you’re circumcised, would you be able to stop using them? No. You’d have to use them either way. So from a practical standpoint, how much difference does it really make?
Wash your baby boy, take him regularly for his checkups, and teach him about hygiene and safe sex practices as he grows older—whether he’s circumcised or not. There’s nothing that the 70 percent of the world’s males who are uncircumcised are suffering from that’s bad enough to justify compulsory, routine, across-the-board genital mutilation of the other 30 percent, as per Dr. Morris’ fantasy.
And if you’re still worried, look up the countries with the highest life expectancies. Take the ones near the top and look up their circumcision rates. Your sons will be fine.