Never-ending dispute: Circumcision

Circumcision in Ancient Egypt

Circumcision in Ancient Egypt

Circumcision involves the removal (by cutting) of the prepuce or foreskin of the penis.  This procedure has been practiced for millennia, grounded in spiritual and cultural tradition across the globe.  The Aztecs, the ancient Egyptians, the tribes of New Guinea, etc. have all engaged in this procedure for a variety of reasons including cleanliness (of spirit and body), freedom from disease, as a symbol of a young man’s transition into adulthood, and as ritualistic baptism for sin.  Given the longstanding and widespread occurrence of circumcision among many varied and distinct ethnic, religious, and cultural social groups, it is important to consider the benefits and risks associated with this practice.  For our purposes, we will review the health risks and benefits of circumcision across the lifespan.  It must be noted that tremendous controversy surrounds this procedure both in the lay and professional audiences in both magazines and professional medical journals.

Circumcision in the Western Hemisphere is often performed during infancy while circumcision in non-Western cultures may be performed at diverse times during the lifespan, particularly in infancy or at puberty.  Regardless of when it is performed, two contexts for the procedure predominate – in a medical environment or as part of a spiritual/religious/cultural environment.

Advocates of male medical circumcision (MMC) typically cite the following male health reasons for performing the procedure and assert that scientific research evidence supports male medical circumcision’s safety and that the benefits outweigh any risks.

Mogen Clamp

Mogen Clamp

  • Bathing and washing of the penis are easier to perform, reducing the health risks associated with poor hygiene including the risk of urinary tract infections
  • Decreased risk of sexually transmitted disease in males specifically Herpes simplex virus type 2 (HSV-2) with a 28 to 34% reduction in acquiring this infection
  • A decreased risk of acquiring human papillomavirus (HPV) infection with a 32% to 35% reduction in risk
  • Decreased risk of syphilis and other sexually transmitted diseases that cause ulcers or other lesions
  • Prevention of penile and anal cancer associated with the human papillomavirus
  • Decreased risk of human immunodeficiency virus (HIV) infection associated with Herpes simplex virus type 2 and syphilis ulcerations amounting to a 53% to 60% reduction in HIV virus acquisition resulting in the procedure being nicknamed “surgical vaccine” against HIV
  • It is estimated that during their lives more than one-third of all uncircumcised males will develop at least one medical condition related to the prepuce/foreskin.

Recent scientific evidence predicts that male medical circumcision will save up to 2 million lives in Africa (within countries with high rates of HIV infection).  Reflecting this scientific evidence supporting the health benefits of male medical circumcision, the World Health Organization has developed a manual (The WHO Manual of Male Circumcision) that includes multiple, different procedures to circumcise infants, boys, and adult males.

Advocates of male medical circumcision typically cite the following female health reason for performing the procedure:

  • Decreased risk of Trichomonas vaginalis infection (yeast infection) by 48% in female partners of circumcised males
  • Decreased risk of bacterial vaginosis (non-specific vaginal infection) by 40% in female partners of circumcised males
  • Decreased transmission risk of other sexually transmitted diseases from male partner including Herpes simplex virus type 2 (HSV-2) and human papillomavirus (HPV) infections and syphilis
  • Decreased transmission risk of human immunodeficiency virus (HIV infection) associated with Herpes simplex virus type 2 and syphilis

Opposition to male medical circumcision are equally vocal in their disapproval of this procedure asserting that scientific evidence fails to support the benefits of routine circumcision and that risks associated with the procedure abound.  More recently, opponents of male medical circumcision have resorted to the public forum in attempts to ban the procedure via legislation in both the United States and Europe.  If such measures were passed, parents and medical practitioners could face criminal charges for performing preventative, routine male medical circumcisions in the absence of specific conditions.

Representatives of the opposition to male medical circumcision are comprised of both lay people and health care practitioners and they assert that:

Circumcision is a surgical procedure causing an infant boy pain

Circumcision is a surgical procedure causing an infant boy pain

  • Circumcision is a surgical procedure causing an infant boy pain
  • (lasting for 7 to 10 days until healing occurs) and accompanied by all of the health risks associated with any surgery including infection, excessive bleeding, scarring, difficulty with urination, and death.  Further, they state that complications occur even in the best-equipped medical settings.

  • Circumcision deprives the individual from the natural protection from injury to the head of the penis that the prepuce/foreskin provides, as well as reducing the natural moisture and lubrication
  • Circumcision reduces the amount of sexual pleasure later in life
  • Circumcision constitutes child abuse and is ethically wrong violating the rights of the child to provide informed consent for the procedure therefore this is a human rights issue
  • Adult males erroneously believe that male medical circumcision prevents them from any risk of contracting human immunodeficiency virus (HIV infection) therefore they no longer practice abstinence or engage in safe sex practices such as condom use
  • Circumcision of infant boys deprives them of the protection urine, feces, and irritation, and keeps contaminants from entering the urinary tract system
  • Circumcision is unnecessary because the argument that it promotes good hygiene and cleanliness is incorrect.  Gentle washing while bathing is easy and as the boy ages, he can be taught how to pull back his foreskin to wash his penis
  • Babies die each year from preventative, routine male medical circumcisions performed by competent medical doctors
  • In adulthood, many men feel sadness, a sense of loss and inadequacy and anger at being mutilated therefore they emotional health is damaged
  • The scientific, medical literature supporting preventative, routine, male medical circumcision is flawed because much of the research was conducted in Africa (due to extremely high rates of HIV infection) and therefore it does not relate to industrialized countries
  • Circumcision adversely affects the male’s female partner because the circumcised penis drags moisture for the female partner resulting in dryness and subsequent difficulties achieving orgasm
  • Circumcision in infancy results in harbored or hidden rage towards the infant’s mother and consequently higher rates of teenage suicide and violence occur in circumcised individuals