Universal Circumcision Is The Dumbest Proposal Ever

JesusForeskin

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.

Why?

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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.

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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.

Photo—Sharon Mollerus/Flickr

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About Ali A. Rizvi

Ali A. Rizvi is a writer, physician, and musician who lives in Toronto, Ontario. Having grown up in four different countries on three different continents, his interests are as diverse as the people he has met, known, befriended, and loved through his life. Ali likes being a man, and wants to continue being one for a while yet.

Comments

  1. Thank you so much for this.

    I once found a study a while back indicating a positive correlation between women who’d been circumcised and their HIV infection rate – think it was in Tanzania.

    Guess how popular that observation was among anti-FGM activists online when I mentioned it. Whereas it’s seen as perfectly acceptable to make silly appeals to science when it comes to the matter of the bodily integrity of baby boys.

    The bodily integrity of males is simply not respected at all with respect to this issue.

    • OirishM, do you have any idea what female circumcision consists of? To cut off a female’s clitoris is the same as having a male’s penis cut off. You can’t compare male circumcision to female circumcision.
      Not only is the clitoris removed, but many times the vagina is sewn almost closed.

      • Ann, do you realize that the clitoris completely surrounds the vagina, so the part that is removed is actually only the “tip of the iceberg”? Removing that part of the clitoris IS NOT the equivalent of cutting off the penis. Women can still reproduce without their clits. Men can’t reproduce without their penis. And please don’t spread the lie that “many times” the vagina is sewn up. That is the rarest form of FGM. The more common is removing the very tip of their external clit or even just a scraping. And in worse case scenarios, men DO lose their whole penis. And they do sometimes die. So yeah, you CAN compare male circumcision to female circumcision. All genital cutting of minors is wrong and all of it should be outlawed!

        • To cut off a female’s clitoris is the same as having a male’s penis cut off.
          No. Cutting off the clitoris is the same as removing the glans (head) of a male’s penis. But that’s just in terms of biology however the differences don’t end there.

          If the clitoris is removed the female in question still has a fully intact urethra. A male that’s had the glans of his penis removed does not.

          If the clitoris is removed the female in question still has a fully intact reproductive system. A male that’s had the glans of his penis removed does not.

          Simply put other than sexual pleasure what function does the clitoris have? (No I’m not asking this to say that its okay to remove it.)

      • Ann, this comment speaks to your ignorance about the topic of female circumcision. You talk about female circumcision as if it were all one and the same procedure. Even the WHO recognizes that there are more than one variation, ranging from minor to very severe.

        Not all forms of female circumcision remove the clitoris, or, as it has already been explained, the tip of the clitoris, and actually, FGM where the vulva is seen shut is the rarest form, at 15% of all FGM globally.

        As it has already been explained on this article, the AAP tried to get away with endorsing what it calls a “ritual nick,” where, according to their own admission, it would be less severe than male infant circumcision.

        In the US, there is a ban on all female circumcision, where all forms, from the most benign to the most severe, constitute “mutilation.”

        Get this; research reveals that women who have undergone circumcision can still experience orgasm, even women who lack a clitoris and/or have undergone the most severe form of FGM, also known as infibulation, or “pharaonic circumcision.” Sarah Johnsdotter, who is against FGM by the way, has conducted extensive studies, and women in communities in Africa where FGM is the norm, claim to have fulfilling sexual lives.

        But we digress. It doesn’t matter if FGM is better or worse than MGM. It doesn’t matter if sex is diminished or improved. The crux of the argument is the principle that you don’t take a healthy, non-consenting person and cut any part of his/her body, unless there is absolute medical necessity.

        If it is wrong in one sex, it is wrong in the other. FGM is not justified if it just removes “a little piece of skin.” The same applies to MGM. GM is ethically repugnant practice unless there is informed consent from the person whose genitals are in question, or there is present medical need. Reaping profit from any other non-medical surgery on healthy, non-consenting minors constitutes medical fraud. Coercing a parent to have their child undergo needless surgery takes it to a whole different level of abuse.

      • Jack Perry says:

        PartS of the penis are cut off with male genital cutting — in fact they are the most innervated parts. The most common female genital cutting (a Muslim practice) is the cutting of the clitoral hood (female prepuce).

        The studies that female genital cutting lowers HIV risk are:
        Stallings et al. (2009) reported that, in Tanzanian women, the risk of HIV among women who had undergone Female Circumcision was roughly half that of women who had not.
        Kanki et al. reported that, in Senegalese prostitutes, women who had undergone Female Circumcision had a significantly decreased risk of HIV-2 infection when compared to those who had not.
        There are others “Georgia State University, Public Health Theses” — a USA University of international renown: The Association between Female Genital Mutilation (FGM) and the Risk of HIV/AIDS in Kenyan Girls and Women (15-49 Years)

        Certainly if male prepuce amputation lowers HIV risk, it is likely that female prepuce/labia amputation would also lower HIV risk.

        In any case, forced (or coerced) genital cutting is abhorrent and must be stopped.

      • Ann, people have already pointed out that FGM is on a spectrum – and if ritual nicking of the clitoral hood is feverishly damned as “mutilation”, then removal of the foreskin definitely is.

        The point is, female bodily integrity is respected here. Not even a ceremonial nick is acceptable. Zero tolerance. Science doesn’t come into it.

        Don’t try and pass off the differences between MGM and FGM as a justifcation for using science to support MGM. They do not justify doing so. The only relevant similarity here is the concern for bodily integrity.

      • Circ Mirror says:

        Ann, I mean no insult when I say this but you are ignorant of the diverse forms that male and female genital cutting can take. I would strongly recommend that you read this; A rose by any other name? Rethinking the similarities and differences between male and female genital cutting. Darby R, Svoboda JS.

        http://www.ncbi.nlm.nih.gov/pubmed/17937251

      • Actually… it can be compared! Removing the female clitoris or male foreskin both do not interfere with the ability to sexually reproduce. Both can still have/create children. The female clitoris has a bunch of sensitive nerves, that are great for stimulating arousal, causing pleasure, & can help contribute to causing an orgasm. Guess what? The male foreskin also has tons of nerves! Foreskin is also highly sensitive. It also contributes to sexual pleasure & helps contribute to male orgasm! So removing a clitoris is just as bad as removing foreskin! It’s the same thing!

        When you get down to it… look at the human fetus while it’s still in the womb growing. Even though our chromosomes had predetermined what gender we will become, our genitals start out looking the same. The “bud” that is there either transforms into the female clitoris or into the head of the male penis. Both of which are protected to remain sensitive by foreskin. Yes, women have foreskin too! We more commonly call it, however, a “Clitoral Hood” instead. In FGM, part of the clitoris that gets removed, also includes that hood! So again… FGM is the same as male circumcision. “Circumcision” is just a fancy word for mutilation, regardless of gender! If people are willing to protect girls from such butchery, then they also need to reach out & just as strongly protect boys too!

  2. Actually, according to the American Cancer Society, one in six males will be diagnosed with prostate cancer. It makes a lot more sense to remove the prostate, as it is more life threatening than breast cancer.

    A bit of trivia; while Brian Morris recommends circumcision to reduce prostate and penile cancer, the ACS does not.

  3. Nononononononononono. I belong to religion that endorses circumcision which is considered different as it is restricted a religious community and its laws but even so, to make it law for everyone? HELL NO

    • It doesn’t matter what religion you are. Your child is not religious. It is unethical and immoral to impose your religion on your child by literally carving it into him. Would you do it to your girls? I’m sorry but religion is not a justifiable reason for cutting off the most sensitive part of a boy’s body. When he is of age (18, the age we allow young adults to make any body modification decisions), he can choose to express his religious beliefs by being circumcised. His parents have no rights to cut off part of his genitals. None.

    • If you actually take seriously any mythological beliefs that suggest that the first thing you should do to your innocent newborn baby boy (the closest thing to a ‘miracle’ if there ever was one) is chop away at his genitals, it may be a good idea to check into therapy. When Abraham heard the voices in his head to kill his first-born son, he wasn’t showing his love for God. He was showing symptoms of a serious delusional disorder (which may be close to the same thing). When he stopped short of cutting off his son’s head, God told him to cut the little one instead. If you’d like to apply these archaic, ludicrous fairy tales to reality in the 21st century, it may be better not to have any children in the first place.

    • Being under the delusion that your mystical sky-daddy insists you mutilate young children’s bodies is the vilest imaginable, (almost), practise.
      It is about time religion was called on this BS. It is no longer OK to cite religious beliefs to explain your barbaric habits.
      Religious beliefs deserve NO respect. Offended? I don’t care!! Deal with it!!

  4. David Wise says:

    This article cherry picks the statistics. Africa has the highest HIV infection rate and I’m sure the circumcision numbers are pretty low there.

    • Theorema Egregium says:

      Not necessarily. Large parts of Africa are Islamic. Also many cultures there have always traditionally practised MGM and FGM apart from religious reasons (e.g. the Maasai).

    • Not true. African countries like Nigeria, Uganda, etc have large Muslim population and high circumcision prevalence. And by the way, the trials done there were done on adults who consented to the procedure, not newborn children.

    • “Africa” is a very large continent of some 60 countries. In 10 out of 18 countries (most of them in Africa) for which USAID has figures, more of the circumcised men have HIV than the non-circumcised. This is much more accurate than a country-against-country comparison and it has never been explained. Since in the other countries more of the non-circumcised men have HIV, It strongly suggests that circumcision itself has no effect whatsoever on HIV and something else is responsible for the local differences. That something might be the cultural context in which circumcision is done – for example whether the culture also practices widow-inheritance or “dry sex”.

  5. Dan Bollinger says:

    Yeh, dumb idea. Just as dumb as universal female circumcision.

  6. Bluecast says:

    Ann was simply trying to gain approval by showcasing how well conditioned she is.

  7. I’m chuffed this issue is getting discussed on this forum: circumcision is a barbaric process that must end.

    An intact penis should be the norm throughout society.

  8. This body, this choice.
    In normal country who respect the basic human right circumcision (girls and boy) would be prohibited on minor.
    Not speak to me of women’s rights or equality time that sexual mutilation on boys will not be banned.

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