Allegation 1: The foreskin is the natural protective covering for the glans and protects it from injury.

  It is nowadays thought that the foreskin might have served as some kind of protection from shrubs, rocks etc. when our ancestors were still walking around naked and "all fours". In other words: it is a by-product of evolution [1]. Since this is no longer the case, the foreskin has become a liability: instead of offering any "protection", the warm and moist area under the foreskin acts as an ideal breeding ground for a host of bacteria, fungi and germs which are known to be responsible for a variety of diseases and infections [1], [2], [20].

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Allegation 2: Circumcision amounts to the "amputation" of a normal, functional body part.

  Calling circumcision an "amputation" is a deliberate exaggeration that is used to to frighten prospective parents or instill a feeling of dissatisfaction and loss in those who had been circumcised as infants (see also the discussion below). Circumcision amounts to the removal of between 20% - 50% of the foreskin depending on the method used. It can therefore in no way be described as an "amputation".

  The claim is sometimes made that a baby is born with a perfect body, and that the foreskin must therefore serve a purpose like protecting the glans of the penis. That might have been the case if humans were still walking around naked. The question why human males are still born with a foreskin can of course be asked. It should, however, be born in mind that human beings have only been wearing clothing of any sort for the last 10-20 thousand years. On the evolutionary time-scale this constitutes a very brief period - certainly too short to have given nature time enough to do away with the foreskin!

  Another significant - and interesting - fact is that the only human cultures to routinely wear no clothing are all uncircumcised: in many of these cultures, a male with an exposed glans is considered "naked", i.e. the foreskin acts as a kind of natural covering. Circumcision is therefore exclusively associated with clothed man.

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Allegation 3: Circumcision is a traumatic and painful experience for the newborn infant.

  The issue of how much pain infants experience during circumcision is a very controversial and hotly debated subject [1], [2]. Even though it is nowadays generally agreed that newborns experience pain more intensely than was previously thought, there are still those who regard the potentials dangers involved in administering anesthesia to newborns to outweigh the benefits [3].

  In the most recent report of the Task Force on Circumcision of the AAP, issued in March 1999, three forms of pain relief was reviewed. The methods deemed most effective was the use of either a local anesthetic cream (applied about an hour before the procedure), or a subcutaneous ring block [18]. Alternative forms of analgesia like sugar coated pacifiers [4] or even a drop of alcohol (like wine, which is often used at Jewish circumcisions) have also been advocated for use in conjunction with the anesthetics named above.

  Regardless of what kind of pain relief is used, parents can ensure that the circumcision of their newborn is made as comfortable as possible by on the one hand being there to comfort him, and also by choosing a qualified operator to do the operation, which will minimize the time needed to do the operation.

  Circumcisions performed on newborns normally only take between 5 to 10 minutes. With the use of anesthesia and/or analgesia, the discomfort and pain to the infant can be almost totally eliminated. Under these conditions, the claim that circumcision is a "traumatic" experience is clearly false and misleading.

  Parents should also bear in mind that studies have shown that the crying observed in babies during circumcision is often not pain-related (if some kind of pain relief is used), but instead might be caused by the discomfort of being strapped into a circumstraint (the apparatus that is used to restrain the baby during circumcision). However, these days more gentler ways of constraining the baby during the operation are often used instead.

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Allegation 4: Circumcision is a dangerous surgical procedure.

  Circumcision is a surgical procedure - albeit a minor one - and therefore inherently carries some risks. However, medical studies done over the past decades have provided overwhelming evidence that, if performed by an experienced operator, circumcision is a very safe surgical procedure. Like all minor operations, complications might arise for a number of reasons. The most common ones [6], [1], [24] include:
(i) excessive bleeding (occurring in one in every 1000 cases) which can normally easily be stopped by e.g. applying pressure or using a locally acting agents;
(ii) local infections (which occurs in one to ten out of every thousand circumcisions) which can easily be treated by antibiotics;
(iii) mortalities: according to medical records, three deaths were recorded in the period 1954-1989 out of a total of more than 50 million circumcisions. It should be noted, however, that two of these deaths occurred during at-home circumcisions by non-physicians [24]. Only one fatality has been reported since then in Miami. In this instance, the death was due to the fact that excessive bleeding went unheeded by the baby-sitter until it was too late. If the bleeding had been noticed earlier, this death could have been avoided.

  The statistics listed above clearly refute the statement that circumcision is a dangerous surgical procedure.

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Allegation 5: Infants who are circumcised can remember the pain for a long time afterwards.

  A recent medical study has shown that infants who were circumcised without pain relief reacted more intensely to pain during immunization injections at 6 months of age than those infants who were circumcised using pain relief or were uncircumcised [23]. This study is (by the authors´ own admittance) only based on a small statistical sample, so more research into this subject is needed.

  There is however no medical or scientific evidence that circumcision has long term effects on how infants (or even adults) react to pain, or that those who were circumcised (without pain relief) can remember the pain. The allegations made by activists like Goldman [21] and repeated on many of the anti-circumcision sites on the web are therefore just wild and unsubstantiated claims that are not supported by any credible medical studies whatsoever.

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Allegation 6: Circumcision disrupts the mother-child bonding.

  If the circumcision was done without effective anesthesia, it may sometimes happen that the infant does not wish to suckle for a brief period afterwards. Most observations of babies have shown that they almost always calm down within 24 hours after the circumcision was performed [5]. There is furthermore no scientific evidence that the mother-child bonding is negatively influenced compared to the case for uncircumcised infants. It should also be noted that if effective anesthesia is provided, the infant is usually back to normal right away.

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Allegation 7: Circumcision is to blame for many social and psychological problems in adult males.

  During the past 20 years or so various "support" groups for of men who were circumcised as infants have been formed. These groups claim that they believe that have been harmed by circumcision, that they feel psychologically damaged and mutilated by it and that their sex lives had been ruined by the lack of a foreskin.

  As discussed in a separate Section , it has been the aim of the anti-circumcision lobby to make - and support - these claims in order to further their cause of stopping circumcision. It is, after all, hard to get people to change their views about a subject if they are happy about it.

  The easiest - and most susceptible - targets for this propaganda are those men who - for whatever reason - are unhappy with their lives and/or with their bodies, and as a result suffer from low self-esteem. To these people, circumcision becomes an easy target - and a convenient scape goat - for all their problems [25] .

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Allegation 8: Male circumcision is basically the same as Female Genital Mutilation (FGM).

  Male circumcision and female genital mutilation (sometimes also incorrectly called "female circumcision") are two completely different procedures. Circumcision of males, except if done for religious reasons, is considered by most people as a prophylactic (health) procedure. FGM - by its nature - usually results in the mutilation of the female sexual organ, which makes it very hard for the person involved to experience any sexual pleasure [7]. The equivalent of FGM in males would amount to the complete amputation of the penis.

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Allegation 9: An uncircumcised penis can be kept sufficiently clean by proper washing.

  As "cleanliness" is very often mentioned in conjunction with circumcision, this subject has been a favorite target of the opponents of circumcision, who proclaim that the implication that men cannot be entrusted with maintaining their own penile hygiene is an insult to them.

  If humans only needed to use the bathroom once a day, there might at least be some truth in the statement that proper cleaning of the genital area once a day with soap and water is enough. However, since this is not the case, and most men moreover either don´t have the opportunity, inclination or time to clean themselves every time after urinating - as is needed to ensure proper penile hygiene - the statement is clearly false.

  Most parents know how difficult it is to get their children to take a bath or shower every day. Even if they do get them to bathe regularly, parents often fail to instruct their children about proper personal hygiene or see to it that it is also carried out in practice. In uncircumcised boys the foreskin usually cannot be retracted until the age of around six. Cleaning the penis in this instance not only requires extra attention and effort, but becomes absolutely necessary since the non-retractable foreskin can very easily trap dirt, bacteria and germs which can lead to a variety of infections, which in infants and young boys can have serious consequences [22], [26].

From the facts outlined above it is clear that personal hygiene in uncircumcised boys often leaves a lot to be desired. What is more, this situation does not improve in adolescent boys: a recent study of boys in Germany [8] has shown that penile hygiene actually worsens as boys grow older. The reason for this might lie in cultural attitudes towards personal hygiene: in many European societies bathing on a daily basis is not the norm. A recent article in Time Magazine [9] for example mentioned that only 47% of all French men and women bathe on a daily basis. Taking into account the fact that most males in Europe are uncircumcised, the scenario discussed above paints a pretty dire picture of (especially) male personal hygiene in those societies. Most people will probably agree that this is hardly an ideal to strive for. Most heterosexual women also have a preference for circumcised sexual partners (see discussion below).

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Allegation 10: The foreskin plays an integral part in facilitating intercourse and in experiencing sexual pleasure.

  The experience of pleasure during sexual intercourse by circumcised and uncircumcised men is totally different, and therefore not directly comparable. After circumcision the glans develops a thin but tough protective layer of skin cells. This so-called keratinization process results in a layer only 10 or so cells think - about as thick as Saran Wrap. This is not enough to to significantly alter sexual intercourse, but instead creates a barrier against viruses and pathogenic bacteria.

  Opponents of circumcision allege that this protective layer of skin on the glans makes it less sensitive. There is no proof of this statement - many men circumcised as adults claim that once the glans becomes moist (e.g. during sexual intercourse), it has nearly identical sensitivity with that of the uncircumcised penis [10].

  Many men have also reported that the foreskin, instead of "facilitating" sexual intercourse, actually hinders it [10] because the glans is covered for a lot of the time, thereby reducing the sensitivity experienced by both partners. Even though the exposed glans is less sensitive than in the uncircumcised case, the former regains a lot of its sensitivity when the glans becomes moist (due to the use of lubricants or naturally during intercourse). Also, contrary to the claim often repeated by the anti-circumcision lobby, the foreskin is not the only erogenous part of the penis! Another advantage of circumcision is that the glans becomes enlarged (since it is no longer restricted by the foreskin), which many women find sexually very stimulating. Taking into account the factors mentioned here, as well as the much improved hygienic state of the circumcised penis, it should come as no surprise that a survey of women demonstrated female sexual preference for circumcised men [11].

  A recent study by researchers from the University of Chicago, based on a survey of 1400 men, moreover indicated that circumcised men have more varied sex lives [12]. This finding should not be surprising: oral sex, for example, is more likely to be a cleaner and more enjoyable experience for women if their partner is circumcised. The facts mentioned here hardly support the premis that circumcised men suffer from reduced sexual pleasure.

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Allegation 11: Circumcision can lead to sexual dysfunction in later life.

  During the last few years, the claim that circumcision can cause sexual dysfunction has been widely publicized by the opponents of circumcision. This claim is, however, not supported by any credible scientific studies. As a mater of fact, just the opposite is the case: the study quoted above [12] showed that circumcised men suffer less sexual dysfunction, especially if they are over the age of 45!

  Many of the causes that may lead to sexual problems are directly eliminated by circumcision. Some of the commonest of these include phimosis, balanitis, genital infections (due to the presence of bacteria or fungi under the foreskin) and premature ejaculation. Any one (or combination) of these factors can have a negative effect on a person's sex life.

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Allegation 12: Circumcision amounts to the "mutilation" of a sexual organ.

  A well-known researcher has made the comment that "comparing circumcision to amputation is akin to comparing a nose-job to decapitation merely because both events occur above the neck!". It should also be clear from the previous discussions that this statement is utter nonsence.

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Allegation 13: Infant circumcision violates the (human) rights of the the child since it is done without his consent.

  From the day that a child is born until it is old enough to make its own decisions, it is the responsibility of the parents to look after the welfare of their child. This means making decisions that they believe will be in their child´s best interest. If parents are convinced that circumcision will benefit their child, they have the legal and moral right to make this decision for him. This is, after all, what parenthood is all about [13]. In the light of this, some of the comments made by those opposed to the procedure (e.g. that infant circumcision "is an atrocity and a fraud; that it´s brutal, perverse, outrageous violation ...") can only be described as being bizarre on the one hand and totally misguided on the other. Some even equate circumcision with child abuse. Comments like these are irresponsible, not only because they are totally false, but also because they trivialize real suffering and abuse.

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Allegation 14: Circumcision is a waste of money and resources that can be better utilized for other purposes.

  Circumcision is by its nature a prophylactic procedure. As such it is usually performed just after birth in order to prevent medical problems from occurring later in life (adolescence or adulthood). Performed on infants it is a very cheap procedure, costing only in the region of $150-$200. Taking into account the number of problems that can arise in later life due to the lack of circumcision and the high costs involved, if e.g. an operation - or extensive long term medical treatment - is necessary (not to mention the personal inconvenience and potential embarrassment involved), it is clear that circumcision is a very economic and cost effective procedure, that not only saves money for the patient in the long term but also for the health insurance companies.

Moreover, considering that the average delivery can cost anything between $2000 - $6000 (depending on duration of stay, procedures needed etc.), the cost involved for performing the circumcision is almost negligible.

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Allegation 15: If my child is circumcised he will be teased by his peers.

  Since the circumcision rate in the US at present is conservatively estimated to be at least 60% (see below) just the opposite will be the case. It is a well-documented fact [10] that young uncircumcised boys get teased quite a lot when they are amongst their peers, most of whom are circumcised.

  Although the fear of being teased or made fun of should not be an overriding reason for parents to circumcise their newborn, they should certainly keep this fact in mind since it can cause psychological problems for their son when he grows up. There has even been a reported case where a boy circumcised himself (and had to be rushed to hospital) because he could no longer stand the ribbing and teasing inflicted on him by his peers [6].

  Parents should also take note of a recent internet survey of teenage boys which showed that uncircumcised boys are far less satisfied with their status than their circumcised peers [14].

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Allegation 16: The circumcision rate in the USA is continuing to fall.

  According to the National Center for Health Statistics (NCHS) - the body responsible for collecting national statistics - the circumcision rate in the USA reached its peak in the early seventies and then started to fall. This decrease is often ascribed to the statements from the Task Force of the AAP at the time (see below). Current statistics compiled and issued by the NCHS show that for the USA as a whole, the hospital based circumcision rate is around 60%. This number has remained stable throughout the nineties.

  In order to save money, health care providers normally require mothers to leave the hospital within 24 hours after having given birth (unless there were complications or the health of the mother or baby is in doubt). As a result, a large number of circumcisions are performed in out-patient clinics (e.g. doctors´ offices). These circumcisions are not included in the NCHS statistics, since this body only compiles the statistics obtained from hospitals. Furthermore, adding those circumcisions that become medically necessary in adolescence due to problems like phimosis etc. [15] as well as those which are done for personal reasons, the actual circumcision rate in the USA is very likely much higher than value quoted above. A more careful reading of the statistics furthermore shows that in most regions of the US, the rates are far higher than 60%, with the lowest rates reported in California. This low rate is most likely due to the fact that a sizable portion of population are of Hispanic origin, where circumcision is relatively unknown.

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Allegation 17: Most men outside of North America are not circumcised.

  The circumcision rates around the world vary greatly according to geographical region, culture and religion. While it is true that most men in Europe and South America are not circumcised, this is certainly not the case in the Middle East, large parts of Asia and most parts of Africa [16].

  For example, in Africa circumcision is performed either as a religious rite - mostly in the predominantly Muslim regions in Northern and Western Africa - or as as a cultural rite (an initiation into manhood) in most countries in sub-Saharan Africa. The circumcision rate around the world has been estimated to lie between 30-40% [16], which can hardly be considered a negligible percentage.

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Allegation 18: The fact that the majority of men around the world are uncircumcised means that the operation must be unnecessary.

  Those opposed to circumcision often state that e.g. in Scandinavia, where the circumcision rate is around 5%, men seem to cope very well without being circumcised. However, in reality the situation is totally different. Adolescent males - and even adults - often have to put up with years of discomfort and suffering due to the effects of phimosis, balanitis and a host of other complications, because the societies they live in are unaware of these problems and therefore unable to deal with them. This ignorance is often reinforced by cultural and/or religious taboos about discussing any subject involving a sexual organ.

  To make matters even worse, these physical problems often causes sexual dysfunction (which, for example, often happens in the case of phimosis), which in turn can give rise to psychological problems. The incidence of phimosis, especially in adolescent boys, is so widespread in uncircumcised males that there is even a website [17] which deals with the problems associated with it. Those who are lucky get help (usually by being circumcised as adolescents or adults), but many are destined to suffer unnecessarily their whole lives without ever realizing that the problems they are experiencing are not normal and can easily be treated by circumcision.

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Allegation 19: Europeans don´t circumcise their infant children because they are better informed.

  The reason why infant circumcision is rarely performed in most European countries is not because people there made a well-informed decision based on scientific facts and medical evidence. Instead just the opposite is the case - the majority of Europeans have little or no knowledge about the procedure except what they might have gleaned from religious instruction, namely that it is done exclusively for religious reasons by Jews and Muslims.

  This ignorance about circumcision is, moreover, not restricted to the general public: circumcision as a surgical procedure is hardly ever taught at medical schools, which means that most medical personal (doctors and nurses) are also unaware of circumcision as a standard surgical procedure.

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Allegation 20: Europeans consider Americans to be "barbaric" for circumcising their infants sons.

  Since most Europeans are ignorant about the topic of circumcision (see above), it is hard to imagine that they will have any views or opinions on the subject either way.

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Allegation 21: Pediatric Societies around the world are against infant circumcision.

  During the seventies the circumcision rate in the US started to fall after the Task Force of the American Academy of Pediatrics (AAP) Committee for the Newborn reported that "there are no valid medical indications for circumcision" (1971). However, in the light of increasing medical and scientific evidence of the benefits of infant routine circumcision - due also in no small measure to the problems that were starting to develop because of the drop in the number of circumcisions (and were absent before) - the subsequent statements have been modified substantially to "new evidence has suggested possible medical benefits ..." (1989).

  The statement issued by the AAP Task Force on Circumcision in March 1999 stated that circumcision has some health benefits, but that it should not be a routine surgery. Many people - including most of the media - misinterpreted this statement to mean that the AAP no longer recommends infant circumcision. This is, however, not the case. The statement goes on to say that the procedure should not be routinely done, but that parents should consult with their doctor, i.e. they should base their decision on an informed choice [18]. In other words, the decision should not be an automatic one, but should instead be based on the available information about the benefits and risks involved.

  In the 1996 report of the Canadian Pediatric Society no recommendation is made either way. Their statement says that the benefits and harms are evenly balanced, but that parents should be advised of the present state of medical knowledge about the procedure, and that cultural and personal preferences should be taken into account [18].

  In other parts of the world, the working group of the Australian College of Pediatrics has issued a statement in 1995 urging medical practitioners to inform parents about the benefits of circumcision.

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