Cut the Penis, Cut the Risk: Why Circumcision Is A Good Choice

By Guest Blogger | August 31, 2012 11:22 am

Jesse Bering, PhD, is regular contributor to Scientific American, Slate, and other publications. He is the author of the recently released book, Why Is the Penis Shaped Like That? And Other Reflections on Being Human and The Belief Instinct, which the American Library Association named one of the “25 Best Books of 2011.” You can find him here.

spacing is important

For the past seven years, I’ve been in an “interpenile relationship”—I, the lesser of the two you might say, am circumcised; my partner is not. This contrast between our members is not exactly at the top of our list of concerns. But it is nonetheless interesting how my prepuce came to disappear into a medical waste bin in a bustling New Jersey hospital on some springtime day in 1975, whereas his, by contrast, has remained a fellow traveler all the long way from that tiny Mexican village where he slipped from his young mother’s womb on a chilly December morning in 1981. That womb, incidentally, belonged to a Roman Catholic. The one that I bathed in, the place in which I had my “bones and sinews knitted together,” in the words of Job, was the property of a Jew. So despite neither of us being particularly patriotic nor, certainly, religious today, the organs dangling so differently between us are nevertheless the very incarnations of our parents’ vast cultural differences.

Whatever the reasons that previous generations may have had for choosing to remove their infant sons’ foreskins, they were almost always unconvincing. All else being equal—and let me reiterate that caveat because it’s likely to go unnoticed, with some readers eagerly pointing out to me those rare cases of congenital defects in which circumcision can legitimately improve the quality of life for some males, which is of course true—all else being equal, any dubious benefits derived from religious, social, hygienic, or aesthetic reasons are clearly outweighed by the costs of male circumcision. Because of some rabbi in Hackensack shaking his head over my intact genitalia, my parents went unblinkingly along with the amputation of a fully operational, perfectly healthy, and probably adaptive body part, all to sacrifice an ounce of their son’s tender flesh to a god that he would never believe in anyway.

Today, however, all is no longer equal, and the balance between the relative risks and benefits of male circumcision has clearly shifted in the other direction. That is, it has according to the American Academy of Pediatrics, which just earlier this week put out its revised position statement on infant male circumcision. Here’s the money quote:

Systematic evaluation of English-language peer-reviewed literature from 1995 through 2010 indicates that preventive health benefits of elective circumcision of male newborns outweigh the risks of the procedure. Benefits include significant reductions in the risk of urinary tract infection in the first year of life and, subsequently, in the risk of heterosexual acquisition of HIV and the transmission of other sexually transmitted infections.

Many of our parents, it seems, may have actually made the right decision for the wrong reasons. Although the task force behind the Academy’s reassessment stopped short of advising “routine” and “universal” removal of the foreskin for all newborn males, and stressed that it remains a personal decision to be made by informed parents, its language represents an increasingly unambiguous endorsement of male circumcision among the world’s leading health organizations (including the World Health Organization and UNAIDS) . By contrast, many of the world’s leading parents remain skeptical of the findings reviewed by the Academy, questioning both the methodologies and the generalizability of studies conducted overwhelmingly with African populations, in which rates of infection are dramatically higher than those in the US. (For more information on this research, as well as a description of the physical factors responsible for the reduction of HIV acquisition in circumcised males, see my earlier discussion at Scientific American.) The more vocal “intactivists,” who’ve long been protesting what they regard as an antiquated, cruel and unnecessary ritual act against little boys that is just as abhorrent as female clitoridectomy, have also responded bitterly to this newest AAP development, seeing fresh strands in an ongoing web of conspiracy between the major health organizations, third-party insurance companies implementing the policy views of these organizations, and greedy practitioners who mislead parents about the benefits of circumcision only to reap insurance payouts for “mutilating” children’s genitals.

Nonsense. In light of mounting evidence for a significant preventative effect of male circumcision on the virus that causes AIDS, as well as herpes, genital ulcers, and the human papillomavirus (HPV), parents today who opt for the procedure for their sons—unlike the majority of parents in the past—should be fully supported in their decision-making, not slammed with the mutilation rhetoric of self-righteous intactivists out to shame them into joining their campaign. Yet, likewise, parents who have done their research, who have evaluated the pros and cons and concluded that the present science is still not convincing enough to justify circumcision, should be supported in their personal decision to abstain from the AAP’s recommendation.

I don’t have children. The closest I’ve ever come to deciding whether or not to have someone else’s genitals altered is getting my border terrier neutered. I do, however, have a best friend with a male infant, and this newly circumcised child happens to be my godson. What has become increasingly irritable to me, to no foreseeable end (just watch the reactions to this little essay of mine), are the rhetorical tactics of hardliner parents who brazenly intrude on the personal decision-making of other parents such as my friend and her husband, who shout and sermonize at them about male circumcision being an unforgivable choice done only by the uninformed or stupid, and who relentlessly, and with all the delusional conviction of fanatics, spin fanciful yarns about shadowy conspiracies and avaricious doctor-butchers.

What is vital to understand about the AAP’s recommendation is that the Academy is not discounting, in any way, the biological purpose or function of foreskin. What the task force has implied, rather, is that whatever the advantages to being an intact male—such as increased sensitivity of the glans, protection, lubrication facilitating better heterosexual intercourse (in addition to the lubricating properties of shed skin cells and oils that accumulate under foreskins, an accentuated coronal ridge may also retract more vaginal fluids during copulative thrusting)—these advantages are overshadowed in importance by the prophylactic benefits of removing highly receptive HIV target cells that are found on the inner mucosal surface of the foreskin. And when performed by a skilled physician on neonates under sterile conditions, circumcision is a quick, safe, minor procedure.

To circumcise, or not to circumcise? To me, at least, that’s no longer even a question. It remains as much a no-brainer as it was when I first wrote about this issue two years ago. If male circumcision reduces the probability of contracting the HIV virus even a fraction of a percent—let alone the estimated 60 percent reduction that scientists believe it does—then why on earth wouldn’t you choose circumcision? Have you ever seen a person slowly succumb to AIDS? The pain inherent therein is not even in the same galaxy of subjective experience as whatever minute qualia of pleasure may or may not be lost to such a “mutilation.” The sacrifice is no longer one made to a mythological deity, but to the child himself. HIV is not just an African problem, the logistics apply to any part of the world where the virus is found, and circumcision protects against more than this one virus alone. If you want to invest in the probability that your son will grow up to become so unfailingly logical that lust will never, not even once, overcome his level-headedness, and that he will always have both a condom on hand and use it every single time that an opportunity to have intercourse with a potentially infected stranger arises, that’s your prerogative. You’ve probably not interacted with many actual human beings in your life, but, hey, it’s your kid.

One can either listen to outspoken atheist bloggers who can’t seem to understand that this is no longer a religious or cultural issue, the overwrought intactivists attempting to intimidate new parents through strong rhetoric and graphic images of botched circumcisions, the endless stream of nosy polemical parents who are happy to share their judgmental attitudes, or one can take the advice of those who, you know, actually know what the hell they’re talking about. The AAP task force included accomplished pediatric bioethicists, urologists, and anesthesiologists who, in consultation with physician representatives from the Centers for Disease Control and Prevention, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists, tediously analyzed mountains of data (and again, peer-reviewed data that were collected by highly trained epidemiologists) under the watchful glare of an American public, many of whom, the task force knew, would remain unconvinced. And yet, despite the anticipated reaction of skepticism and suspicion, still they arrived at their revised recommendation for male circumcision.

What was once unquestionably “inhumane” and “unethical” has, oddly enough, made a complete about-face as a consequence of vitally important scientific data emerging over the brief span of two highly productive decades. Yet many parents continue to be emotionally sabotaged by the baby-harming language of intactivists and online blowhards, whose rhetoric primes them to either see these critical developments in conspiratorial terms or to indulge in amateurish debunking of complicated research.

So here’s one of those rhetorical devices that intactivists should appreciate: Cut it out. For every amazing prepuce you save, you’re adding an element of risk and uncertainty for the person attached to it. Nobody can possibly know what viral foes a man will come up against in his life, and if one of them is HIV, your crusade, admirable though you feel it is, may be costing some other parent their child’s life.

Image via Shutterstock


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