A circumcision compromise?

By Razib Khan | August 26, 2012 10:17 pm

The New York Times has a piece on an update to the American Academy of Pediatrics position statement on circumcision (shifting toward a more pro-circumcision position of neutrality). In the United States the rates of circumcision for infant boys has gone from 80-90% to ~50% (there are regional variations, so only a minority of boys in the Pacific Northwest are circumcised). A few years ago Jesse Bering put up a post, Is male circumcision a humanitarian act?, where he actually wrote “Nobody knows where your child will live as an adult (perhaps Africa), or how rampant HIV will be there….” I like taking probabilities into account, but this is ridiculous.

Let’s ignore Jewish ritual circumcision, which has to be done in early infancy from what I know. The vast majority of the world’s circumcised men live in Africa and the Muslim world, with a substantial minority in the USA and American-influenced cultures.* So you don’t need to focus on infant circumcision at all. In Turkey circumcision is performed on boys who are considerably older. I understand that an 11 year old boy is not an adult, but if sexually transmitted diseases are your primary concern, then why not diminish some of the ethical concerns (granted, you will not abolish them) with surgery upon infants by pushing back the timeline? You could even push the age to 18 and still gain a lot of your preventive bang-for-the-buck in the United States. A substantial minority of 18 year old adults are virgins, and most of those who have had sex have not had many partners. In Africa free adult circumcisions have been reputedly popular in some areas, so I don’t see the problem if adults are offered this procedure for free.**

* South Korea and Philippines both have widespread circumcision due to American influence. Interestingly, a large number of Americans think that circumcision is a religious mandate for Christians. I’ve had Catholic friends explain it exactly this way, making it quite clear that the stereotype about Catholics not reading the Bible has a lot of validity.

** For the record, I do accept that in Africa male circumcision has some preventative value (there are also cross-country comparisons in Southeast Asia). But it seems like a totally irrelevant issue in most of the developed world. There’s no difference in the AIDS epidemic in South Korea vs. Japan, because both are advanced developing countries, and a society-wide heterosexual AIDS epidemic seems to never materialize in such nations.

CATEGORIZED UNDER: Health
  • Brett

    ** For the record, I do accept that in Africa male circumcision has some preventative value (there are also cross-country comparisons in Southeast Asia).

    Is there? I remember PZ Myers had some pretty harsh criticism of the African studies in terms of methodology.

  • pconroy

    When my son was born in NYU Hospital, I felt I needed to stand vigil over him to stop him from being circumcised. Though there were distinct requests made for no circumcision both verbally and in writing, 2 different nurse picked him up to take him to have the procedure done, as he “hadn’t had his circumcision yet”, as if that and cutting and clamping the umbilical cord were routine procedures to be performed.

    A doctor questioned me about this and when I said we were passing on this, she said she would have to speak to my wife, to make sure that we “both” understood the ramification of not performing this unnecessary surgery.

    All very bizarre to me…

  • https://plus.google.com/109962494182694679780/posts Razib Khan

    there are criticisms to be made. i am persuaded by analogous patterns in southeast asia, though the magnitude of effect is weaker.

  • https://plus.google.com/109962494182694679780/posts Razib Khan

    #2, there are cultural differences within the usa about this. that surely wouldn’t happen in the pacific northwest.

    http://www.circumstitions.com/USA.html

    i do think it’s pretty rude that this happens in the medical field. you’re not the only person who has told me about this sort of thing. you can always circumcise later. you can’t uncircumcise.

  • http://forwhattheywereweare.blogspot.com/ Maju

    The pretext of HIV transmission is the most ridiculous claim ever. It is probably correct that HIV transmission to the penetrating part of coitus (man in heterosexual relations normally) without preservatives is slightly reduced but, logically the greatest risk of HIV transmission is by far in the main direction of fluids (so in the penetrated part, usually the woman in heterosexual relations). Circumcission does nothing about this last except maybe embolden the penetrating part with a false sense of immunity.

    What prevents HIV transmission is avoiding risk practices, like not using condoms. Circumcission has nothing to offer here except to give some men a false sense of immunity and put more women (or receiving participants in homosexual sex) at risk from infected men not using condoms in casual relations.

    The only real reason behind widespread circumcission in the USA and some other Anglosaxon countries is some sort of religious-cultural belief, whose full details I can’t understand. But it’s not because of AIDS and existed before AIDS.

  • https://plus.google.com/109962494182694679780/posts Razib Khan

    The only real reason behind widespread circumcission in the USA and some other Anglosaxon countries is some sort of religious-cultural belief

    it was a particular understanding of hygiene and public health, which was common between the late 19th century and the mid-20th century. you can google it. the USA seems to be the last major redoubt; my understanding is that the UK and australia, and somewhat later canada, shifted away from the practice.

    Circumcission does nothing about this last except maybe embolden the penetrating part with a false sense of immunity.

    i think the logic is that in societies where ‘sexual networks’ are common reducing transmission rates at one point of the node in one direction is useful.

  • http://backreaction.blogspot.com/ Bee

    http://www.spiegel.de/international/germany/commentary-circumcision-without-medical-justification-is-wrong-a-846395.html

    Some context here

    http://www.spiegel.de/international/germany/religious-communities-debate-court-s-circumcision-ruling-a-841276.html

    It is beyond me how anybody can tolerate infants being unnecessarily subject to pain and health risk without any medical indication requiring the procedure. A surgery is a surgery is a surgery.

  • https://plus.google.com/109962494182694679780/posts Razib Khan

    subject to pain

    i remember my brother screaming when they circumcised him. it was in a small clinic and i was in the waiting room. pretty disturbing. though in my family’s hanafi islamic tradition circumcision is not obligatory as a religious rite, so it’s not that big of a deal

    http://en.wikipedia.org/wiki/Khitan_(circumcision)#Religious_sources

  • http://www.facebook.com/doclonglegs Andrew Selvarasa

    You’re right about Canada. My mother is Guyanese, and my father is Sri Lankan. At the the time of my birth, they were both Christians (atheists now after hearing me gab about science non-stop). I was born in 1986, and both of my parents were vehemently against the circumcision of my wiener despite their Christianity. The same goes for my brother born in 1994. Now, this isn’t surprising, as most brownz around here do not bother with circumcision despite their religion; however, my white and black friends, either atheist, Jewish or Christian, are not circumcised either.

    Circumcision is now viewed as a barbaric, ancient practice around these parts. I’m glad.

  • https://plus.google.com/109962494182694679780/posts Razib Khan

    #9, from what i know people from dharmic backgrounds are particularly averse to the practice, and muslims are particular keen on it, because it sets the two groups apart. in bengali the term for circumcision is very close to ‘making-one-muslim’ (mussulmani). as i stated above there is no association between christianity and circumcision as such. arab christians circumcise, but arabs circumcised in antiquity as well. european christians never circumcised, except for idiosyncratic reasons.

  • http://www.facebook.com/doclonglegs Andrew Selvarasa

    Thank you for the additional info. :)

  • http://econstudentlog.wordpress.com US

    I have not seen this paper discussed anywhere outside Denmark, so on the off chance that people here don’t know about it:

    http://www.davidwilton.com/files/mc-and-sexual-function—denmark-2011.pdf

    This should probably be a factor to consider as well for parents contemplating circumcising their child.

  • April Brown

    My son was born in London, and the midwives, seeing that I was an American, were proactively pissy with me, ready to twist my barbaric American arm into not mutilating my child. When I made it clear I wasn’t going to circumcise him, they just looked kind of bewildered and confused. It got worse when I also didn’t demand a C-section just for the hell of it. They were all geared up to force me out of my wrong American beliefs and all they got to do in the end was give me a pamplet about the risks of epidurals.

  • Darkseid

    i agree there’s no reason to do it in industrialized countries but i’m much more offended by religious, obese, low IQ and people with genetic defects having kids. the children don’t have a choice in those either. technically, you can stretch your foreskin back out if you really want it back that badly although i know it’s a….stretch saying that someone would actually do that.

  • Jack Perry

    I would expect that anyone that watches this would never cut off parts their baby boy. :http://www.youtube.com/watch?v=DD2yW7AaZFw&sns=em

    In the US population the cut men get HIV at the same rate as natural (intact) men. Mostly natural Europe gets HIV at a lower rate than mostly cut America. The AAP is changing their statement based on claims from Africa of HIV studies. These contradict real population data from Africa where circumcised men get HIV at the same rate or an even higher rate as natural men. Numerous studies document that erectile dysfunction and loss of sensitivity is a significant issue for cut men. There is no STD advantage, just sexual dysfunction.

    Shame on the AAP for not considering the harm! Have they no sense of decency?

    Especially pediatricians should First do no harm!

  • Chris

    As someone who was circumcised (at least I’m assuming from how it looks) and really has no problem with it, I’m happy it was done as an infant. If it hurt, I have absolutely no memory of it. And how can you miss something you’ve never had? It would be much crueler to do it past the age of four when you are able retain those memories into adulthood.

  • pconroy

    @15, Chris,

    My wife dragged me to a public meeting on this about 4 years ago – as the New York Health Dept were considering issuing a recommendation that at risk groups for AIDS/HIV be circumcised.

    A speaker against this had some data that circumcised men , IIRC, lose 22 % of their sensitivity, due to circumcision. So he was likening the procedure to a partial Clitoridectomy.

    So it’s possible that circumcised men enjoy sex less than intact men – but they just don’t know that?!

  • Naughtius Maximus

    Didn’t Germany pass a very strong anti circumcision law recently (I can’t remember if it banned it completely until a certain age)?

  • nan

    pconroy: I don’t think you can reduce human sexual pleasure so easily to a count of nerve endings. It’s true that an intact foreskin (I’m fortunate to have one) is at least as sensitive as the area around it and maybe more, but I think the brain would adapt and build a new map, particularly that of an infant. Sex seems designed to overwhelm the senses anyway.

    In the West the removal of a pleasure organ and assumed reduction of motivating pleasure is part of the point, along with the romantic picture of male as unrestrainable animal (including the usual dose of phallic worship). Still fun as roleplay but not so good for social medical policy.

    For me it comes down to cutting people up without their informed consent.

  • Thursday

    IIRC, adult circumcision causes a reduction in sensation while infant circumcision does not.

    Also, it is isn’t just AIDS. Circumcision seems to almost completely prevent cancer of the penis.

    This doesn’t mean one should do circumcision, but I just can’t see it as all that terrible. Certainly not terrible enough to override long standing religious traditions.

  • pconroy

    @20, Thursday,

    Except for most US guys who are circumcised, there are no “long standing religious traditions” to override?!

    It’s just a relatively recent cultural fad…

  • Dick Scalper

    They brand men like a herd of cows. American men are such wimps to let their sons be subjected to this absurd surgery. If it were women tied down & cut, the Feminists would be howling all over the world. The male genitals are a cheap commodity. There is no argument too absurd for the circumcisers. They insult the appearance of the intact penis, claim that circumcision heals everything from body warts to HIV, and draw an illogical distinction between female & male genitals. Circumcision is the mark of a slave, my friends.

  • Anthony

    I’m uncircumcised, though born in the U.S. in the 1960s, when that was a rarity. (Both parents were immigrants, and didn’t see the need, and probably didn’t want to pay for it, either.) I distinctly remember as a young boy – about 4 or 5, having some sort of inflammation, and being taken to the doctor, who gave instructions to me and my mother that I needed to clean under the foreskin regularly to prevent future recurrences. So far, in the past 40 years, I haven’t had any recurrences.

  • Surly

    The “evidence” people cite against circumcision’s STI-prevention benefits is inevitably hilarious. As is how worked up they get about it.

  • http://forwhattheywereweare.blogspot.com/ Maju

    As I see it, cricumcission is akin to female genital mutilation, even if maybe not in the most extreme forms (clitoris ablation) but certainly in its “milder” ones (labial ablation and such). I think that no religious dogma can be pretext for it in minors. If adults want to go through the procedure once they are 18 y.o., that’s their problem. This is similar to Jehova Witnesses attempting to forbid blood transfussions to their children: it just cannot be accepted because it harms the minor and the state must protect minors from their parents, when these are harmful (in the name of religion or crack I could not care less).

    Of course I understand that these views are controversial because religious and “family values” fanatics want to have their way with their children but it’s simply not right.

  • Eurologist

    “Didn’t Germany pass a very strong anti circumcision law recently (I can’t remember if it banned it completely until a certain age)?”

    No – there was a local judge that raised that question (there isn’t a “precedent” analogue in German Law). Still, lawmakers will have to find ways to make circumcision legal for specific religious reasons.

    I had to specifically “opt out” for my son in California – so I can confirm that in much of the US, circumcision is the default.

    From personal, i.e. anecdotal information, I agree that the inside of the foreskin is actually more sensitive than the glans.

    There was a recent article (on CNN?) that tried to argue the huge cost savings of preventative circumcision. However, when I looked at the numbers, it seemed to me that doing circumcisions population-wide was a far larger cost. YMMV.

  • http://thefloatinglantern.wordpress.com Tim Martin

    Pardon my ignorance of the history of circumcision, but would anyone have even *thought* to cut off a boy’s foreskin for medical reasons if it hadn’t already been a religious or cultural practice to do so?

  • pconroy

    @27, Tim,

    Right – it’s just a post-hoc rationalization that genital mutilation confers some good on the unwilling recipient!

  • Karl Zimmerman

    27 -

    Foreskins do have a tendency to get infected. Both my father and my maternal grandfather were originally uncircumcised, but due to medical necessity needed the foreskin removed. Actually, I think my father needed a tad bit more removed, but the less detail I know about that, the better.

    It was the family history of “foreskin problems” which caused my mother to decide to circumcise my brother and I.

  • princenuadha

    ” Tim Martin Says: August 28th, 2012 at 10:33 am Pardon my ignorance of the history of circumcision, but would anyone have even *thought* to cut off a boy’s foreskin for medical reasons if it hadn’t already been a religious or cultural practice to do so?”

    Of course! Just like we all think of cutting off women’s breast to stop breast cancer… Sarcasm. Ironically, cutting off the breast would probably be far more effective than circumsision.

  • http://thefloatinglantern.wordpress.com Tim Martin

    @Karl: Huh, I didn’t know that. Thanks.

  • pconroy

    @29, 31,

    I’m intact as are most Irishmen, and I’ve never heard anyone ever mentioning any problems with having a foreskin… quite the opposite in fact?!

    Most US Readers probably do not realize that the foreskin provides a natural protective cover to the glans, without which the skin of the glans gets up to 15 times thicker, and looses a lot of sensitivity.

    Plus, there is no need to use any “rubbing oil” or lubricant of any kind when getting jiggy alone – if you know what I mean?!

    So I’d imagine the original prohibition on foreskins was an attempt to cure masturbation?!

  • http://forwhattheywereweare.blogspot.com/ Maju

    #32: IMO, yes: the unspoken truth behind circumcission is, among others, a blunt attempt to prevent masturbation.

    There may be another less obvious reason however: to inflict Edipic pain from the Parent in the context of the Yahvistic psychology of “fear god, fear authority, fear your dad” – so different from the modern vision (in some parts of the world) of god and dad as some sort of benevolent Santa Claus primarily.

  • Grey

    @32 “So I’d imagine the original prohibition on foreskins was an attempt to cure masturbation”

    Didn’t the phoenicians sacrifice their first-born at one point and then stop? I always assumed circumcision would date from that time (with an echo in the bible story).

    I think the anti-masturbation argument is the likely explanation for why and when it took off in the USA.

  • http://forwhattheywereweare.blogspot.com/ Maju

    #34: Circumcission (like female ablation in various forms) is widespread in Africa also, with strong affinity for Afroasiatic or Sudanid speaking groups, which are usually also pastoralist. It was practiced in ancient Egypt, etc. Body modification is known to exist or have existed in many other culturesin Africa and elsewhere, this is not so peculiar seen from that viewpoint, however affecting sexuality directly… it’s a most controversial issue.

    Also whether Phoenicians practiced human (specifically children) sacrifice has been challenged and is under debate. It did not have to be the first born nor was necessarily a widespread practice in any case: we just do not know much about that and that’s about it.

    Religious pretexts can also be wielded in the case of female ablation: in many parts of Africa it is a religious matter. You know the story of the Fox and the Termit Mound… it’s just like the Genesis or the Quran for them. Same logic for same barbarity.

  • Sandgroper

    The Noongar of south western Australia were the only Australian Aboriginal group that did *not* take up the practice of circumcision, despite a lot of pressure from neighbouring groups to do so.

    In this context, circumcision meant substantial modification with a sharp rock – in some cases, very extensive modification. ‘Whistle dicking’ (cutting a row of holes in the underside of the penis) was a standard joke among Australian schoolboys when I was a kid.

  • pconroy

    @36,

    Yikes – that takes genital mutilation to another more grotesque level…

  • Sandgroper

    @37 – There has been certain past discussion in anthropological circles about why the hell they went in for such extensive and creative mutilation. One theory was that it was intended as a form of birth control, which truly boggles the mind. However, I read an account by one anthropologist who asked some Aboriginal guys in the north west why the hell they did it, and he recorded that they said “To make it more beautiful.” *speechless*

    I don’t know, but imagine the subject is probably now politically taboo. I haven’t seen it discussed for a long time now.

    With some of these cultural things, I think often people really don’t know why they are doing what they are doing, like the doctor telling you she needed consent from both parents *not* to perform unnecessary surgery on an infant incapable of giving consent and without anaesthetic. I got done allegedly because Australian troops in the trenches in France during the Great War had problems with personal hygiene. I imagine they might, but I was born in 1949, for God’s sake – doctors just kept doing it because no one told them that no one was fighting trench warfare any more and that they didn’t need to, and most parents didn’t think to intervene, I suppose because they were lesser people than the Noongar and the Irish.

    Anyway, the Noongar were too smart to fall for that – which is kind of interesting in itself, that some bizarre pointless culture should spread Australia-wide like that but that it should be resisted successfully by one regional group.

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This blog is about evolution, genetics, genomics and their interstices. Please beware that comments are aggressively moderated. Uncivil or churlish comments will likely get you banned immediately, so make any contribution count!

About Razib Khan

I have degrees in biology and biochemistry, a passion for genetics, history, and philosophy, and shrimp is my favorite food. In relation to nationality I'm a American Northwesterner, in politics I'm a reactionary, and as for religion I have none (I'm an atheist). If you want to know more, see the links at http://www.razib.com

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