Circumcision, especially infant circumcision, is a controversial issue. Historically, circumcision was done for cleanliness: ancient societies didn’t have as much in the way of soap. In the US, circumcision is the most common medical procedure. But is it still practical?
In the circumcision procedure, the foreskin is held out, cut with a knife, and the new edge is sewn shut right below the rim of penis head. There isn’t a perfectly clear cutoff line, so sometimes incomplete or overzealous circumcisions are performed. Adults are usually given an anesthetic, but infants are not always extended this privilege: there is a general consensus that infants don’t remember the trauma. The exposed mucosal head eventually becomes keratinized like skin over the rest of our bodies.
This keratinization, or toughening, makes the skin more impervious to infections. Uncut men are at increased risk for HIV, HPV (genital warts), UTI’s other STI’s. The foreskin covers a mucus membrane that is easier for viruses and bacteria to infect. However, STI’s are better prevented by the common condom. We don’t need a medical procedure when Trojans and forethought will do just fine.
However, circumcision can be helpful as a disease prevention method in places where HIV is rampant and condom compliance is low, such as many areas of Africa, Asia and the Middle East. In places where HIV is tearing people apart, every extra precaution helps.
Uncircumcised males can suffer from painful conditions called phimosis and paraphimosis. Phimosis is when the foreskin can’t be pulled back past the head of the penis. In adults, a buildup of smegma (dirt and oil) causes the foreskin to literally stick to the head of the penis, which hurts a great deal. In extreme cases, circumcision may be necessary. (Please note, however, that phimosis is normal in young children.)
Paraphimosis is when the foreskin stays pulled back past the head of the penis. It is caused by a buildup of scar tissue and can be painful and dangerous. Paraphimosis can cut off blood circulation to the head of the penis and requires immediate medical attention. Some people advocate stretching the foreskin to prevent or cure paraphimosis, but this can cause small tears and more scar tissue. Circumcision may also be necessary if this situation occurs.
There’s mixed evidence about whether circumcision increases (or decreases) pleasure; pleasure is very objective. The foreskin does have a large number of nerve endings, and intact males tend to orgasm minutes faster. Most men who get adult circumcisions report a decrease in sensation (although a few report an increase). In the cases of adult circumcision, it is unclear whether they have a decreased sensation because the foreskin objectively increased sensation or because they were just used to it. Science is unable to go the other way and attach new foreskins to cut males, so we can’t objectively say the foreskin actually heightens the feeling.
Strangely enough, vanity is the biggest reason for circumcision: parents put their babies under the knife because they think cut penises are more attractive. This astounds me. Our society would never endorse giving our girl babies a cosmetic procedure at birth. Good luck asking for your newborn girl to get breast implants or labiaplasty.
With proper hygiene, there’s not really much of a call to circumcise babies in this day and age. The American Medical Association claims that while there are potential medical benefits, the current data, “are not sufficient to recommend routine [infant] circumcision.” Think: if nobody else in society did it to their kids, would parents still opt for the operation?
Now, do not think I am trivializing female circumcision. Female circumcision (or more correctly, mutilation) is overwhelmingly a barbaric procedure that should have no place in any society. Female mutilation can go as far as to remove the clitoris, clitoral hood and labia and stitching the sides of the vagina together. It is normally practiced on prepubescent girls who vividly remember the pain. Male circumcision in general is very different from female circumcision in terms of lost sensation and pure pain.
I don’t find anything wrong with an ascetically minded motivation for male circumcision, especially when its based in ancient tradition. In ancient Mexico elites used to strap babies heads between padded boards so they would develop in an elongated fashion that was considered attractive, and given the cultural context I don’t find much wrong with that either.
As for FGM, (female genital mutilation) as you say that is an entirely different story. As the Baldwins (the beloved Human Sexuality professors at UCSB) explained it the male equivalent would be cutting off the whole head of the penis. Yeesh.
People have been esthetically altering their bodies since they have been aware of them, and in my opinion the only time to question such a practice is when it is non-consensual, as it most often is in this case. So I appreciate your opening the debate. I’m not saying that it definitely should be done, I’m just saying this: 1. Aesthetics should not be immediately discounted as a legitimate reason, when it is coupled with ancient tradition and the possibility of health benefits. 2. It is not helpful to wonder if no one else did it would some parents still do it. If no one else went to the dentist you and I probably wouldn’t either, and as far as my memory is concerned, the dentist is a lot more traumatizing. 3. There is simply no comparison to giving a newborn breast implants.
Is male circumcision really necessary? Obviously not. But should it be stopped, or looked down upon? I personally don’t think so, especially if it could help avoid STIs, and means someone could take a trip downstairs without the word “smegma” popping into his or her head.
To respond to Alex White, I think it’s perfectly fine to become circumcised if that’s what you like/want. I think that health professionals should encourage adult circumcision as a means to help fight STI’s and other complications I discussed. But I think it’s only something that that male should ultimately decide. If I were a guy, I’d be circumcised. But I wouldn’t want that freedom to choose taken away from. I don’t think it’s something that should be done without consent (ie as an infant). For some reference, infant circumcision is largely unperformed in Europe and in many instances banned in Australia (admittedly biased source: http://www.circinfo.org/). Indeed, Australia has around a 13% infant circumcision rate (source: http://www.cirp.org/library/statistics/Australia/)
Even if the foreskin does nothing for sexual pleasure, as a comparison you wouldn’t get your infant’s appendix removed to prevent the possibility of future infection because it’s unnecessary. Normally you’d wait to get your appendix removed if it got infected. Normally I’d wait to get my penis tip cut after I got phimosis/paraphimosis. Also, condoms and good sense protect better against HIV/STI’s better than a cut penis. Circumcision is invaluable in places like Africa, but it’s not really that helpful here in the states.
And The Baldwins are great, but they’re not perfect!
You forgot the first step in circumcision before the foreskin is held out, when the foreskin is forcibly separated from the glans. The two structures adhere at birth. It normally separates over time, but circumcision before this occurs requires forcible tearing.
(This adhesion is what I think you incorrectly refer to as phimosis in children.)
I have no reason to deny that (voluntary, adult) circumcision helps in preventing HIV transmission. I think the studies were flawed because they weren’t real world, but the results may still be correct. But any protective benefit will not last long-term when males continue to engage in unsafe, promiscuous sex. In the circumcision studies in Kenya, education had a far greater effect in reducing the infection rate. Even among the intact men who received some education, their infection rate remained below 3%, much better than the 6% rate among the general population.
To Alex’s comment, consent without medical need is the issue. When there is consent, aesthetics are as good as any other reason, since all tastes and preferences are subjective. But because all tastes and preferences are subjective, only the person being circumcised may decide whether a subjective reason meets his standard. Only immediate medical need that can’t be resolved with less invasive treatment is a reason to circumcise. Aesthetics are subjective, but so are potential medical benefits like lower risk of STDs. (For instance, my risk is zero because I do not engage in unsafe sex. Circumcision isn’t helping me avoid HIV because I do not have unprotected sex with HIV+ women.)
I do think there’s a valid comparison to giving females forced breast implants. Presumably it would be done to please future sexual partners. I can easily point to many, many examples of parents arguing in favor of circumcision for their sons to please their future partners. Neither is any more irrational than the other.
There’s also an easy comparison to FGM because gender is irrelevant in describing forced genital cutting on a healthy, non-consenting individual. The act – the violation – is the same. Degree of harm does not matter.
Specifically to the degree of harm, there are four recognized types of FGM. Most are much more severe, and unfortunately, they tend to be practiced more. But Type I without excision of the clitoris is undeniably less invasive than typical male circumcision. Yet, we in the West still outlaw any and all female genital cutting. There is a mistake in our thinking, and it’s ethical rather than factual.
Females also produce smegma. We know that’s not a reason to cut them against their consent. Soap and water are still necessary, so that “benefit” is illusory. And how are parents supposed to know that their son’s future partner(s) will have a problem with this? They don’t even need a fetish, just a mutual understanding that basic hygiene is a requirement before sex.
Compare disease rates between industrialized countries. The circumcising U.S. and non-circumcising Europe have extremely similar rates of disease involving the foreskin and penis. Penile cancer rates are actually lower in Denmark than the U.S., for example. And statistics on HIV demonstrate clearly that our crisis is behavioral, based on male-to-male transmission.
I would never have chosen circumcision, had I been given the choice. I don’t need most of the potential benefits because I don’t engage in activities that make me susceptible to disease. As for the other potential benefits, I’m content in understanding that the bulk of causes are behavioral rather than anatomical. For the remaining problems (e.g. UTI) that may occur regardless, I’d be content to follow the same approach that women follow, which is basic medical treatment without cutting. I’m certain that antibiotics work equally well, independent of X-chromosome quantity.
Why should I care what my parents thought, or how well-intentioned they were? They made my choice, against all reason and ethics.
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I do agree that circumcision should not be a routine thing. It is something that parents need to consider and decide for themselves. I don’t think it is harmful either way and I actually lean toward circumcision especially if it has religious significance.
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