• An Appeal to Reason
• Circumcision: the Bottom Line

  Circumcision has been practiced for thousands of years. In fact, it is the oldest reported surgical procedure known to man. Although it is often performed for religious reasons, people early on realized that circumcision also has several health benefits, many of them linked to improved hygiene. Modern medicine has verified many of these benefits. As a result, millions of men have been circumcised in North America during the past 60-80 years alone. The overwhelming majority of them are perfectly happy about it, and why shouldn´t they be: they have, after all, been guaranteed a care-free and hassle-free life when it comes to maters of penile hygiene and health.

  Most people therefore hardly ever give the topic of circumcision any thought unless they are confronted directly by it. Typical examples are prospective parents, and men who are considering circumcision due to problems like phimosis - or even for personal reasons. When these people try to find help or advice, more often than not they are confronted by a barrage of information that is not only incredibly biased and negative, but also presented in a threatening and intimidating manner (for a discussion, see here).

  To most people this will come as a complete surprise. Instead of getting helpful information, one is told - in no uncertain terms - that one has been mutilated (sexually and as a human being), that one´s human rights had been violated, that one might still be suffering from the trauma (and pain) caused by the circumcision etc.. Because of the severity of these allegations, it is no wonder that some individuals start to question a procedure that - up till that point - had rarely been a topic of discussion or thought. An innocent quest for knowledge turns into a very scary and unnerving experience.

  After this initial shock, most people, however, come to realize that what they have read does not agree with their own personal experiences. A more careful reading of the available information brings the realization that, amongst the dozens of sites opposing circumcision, there is not a single one that offers an objective and rational discussion of the subject. Medical studies are used in a totally biased way to emphasize only one side of the issue, and no effort is made to give a broad overview of the subject. By furthermore making outrageous allegations that are not backed up by any credible scientific evidence, these websites exploit people's insecurities and personal problems: circumcision becomes a convenient scapegoat for all possible ills present in modern society. On reflection, however, this behavior of active misinformation should come as no surprise. After all, how else can one discredit a procedure that most people are totally satisfied with and that has served its purpose very well - so well in fact that most people take it totally for granted?

  There are probably several reasons why circumcision has become such a controversial subject. Some of the claims about the benefits of circumcision, first made at the turn of the century when it was prescribed as a treatment for a variety of ailments ranging from paralysis to mental disorders, were certainly exaggerated. In some ways circumcision became the victim of its own success. It is also true that in many cases circumcision was "used" to curb masturbation. This is, however, more a reflection on the kind of prudish society that was prevalent at the time (early 1900's) than on the procedure itself. After the Second World War circumcision became a routine surgery, with most of male infants in North America being circumcised. The main reasons for this was improved genital hygiene, health benefits and cultural preferences. During the sixties, however, many of the traditions and assumptions of society came to be questioned. Circumcision was one of these, with some people starting to question something that was being taken for granted.

  That in itself is, of course, not a bad thing. There is a difference, however, between questioning something and actively trying to stop it altogether by any means at your disposal. And the latter is, unfortunately the way the anti-circumcision cult - for most part - has reacted. Instead of providing unbiased information, they are spreading misinformation and hatred for anything or anyone who is involved in circumcision. The behavior of many of these groups and individuals has become so fanatical, that there have even been reports of pro-circumcision delegates to conferences being forced to check in at hotels using aliases, because they were afraid for their safety (see e.g. an abstract from the Chicago Herald Tribune).

  The public in general - and parents who are acting in their child´s best interest in particular - have the right to know all the available information that there is about circumcision. This includes both the benefits and disadvantages of the procedure. However, reading the information that can be found on the anti-circumcision websites and many of the publication and books that are available, it is hard not to get the impression that the opponents of circumcision are not interested in providing unbiased information and presenting the facts presented in the scientific literature.

  Instead they seem to have only one goal in mind, namely to stop the practice of circumcision alltogether by any means at their disposal, and for whatever reason it may be performed (including religious reasons). Parents who are trying to find information about the subject on internet sites and chatrooms are often harassed and threatened, and made to feel guilty about even considering circumcision for their son. These groups are furthermore not interested in having a constructive dialogue with those people who might disagree with their viewpoints and favor the procedure. Scientific evidence that contradicts their beliefs is ignored or dismissed and often misquoted to instead support their claims. This is not the way that one would expect honest and well-meaning people to react, and most people would agree that this kind of behavior clearly exceeds the bounds of acceptability, and should neither be condoned nor tolerated.  

The anti-circumcision lobby has been active since the late 1960´s, i.e. for at least 3 decades. During this time they have waged a relentless campaign to try and discourage parents from circumcising their infant sons. It is interesting to note that despite these tireless efforts, the circumcision rate in the US remains above 60%. This failure to influence and change the public´s perception - and acceptance - of circumcision has meant that the tactics employed by many of these groups have become more and more desperate (for a discussion, see here). The claims that are now being made have become more and more outlandish - e.g. that circumcision causes long term psychogical problems and is the cause for a lot of the violence present is society. None of these claims is backed up by any credible scientific study.

  There is overwhelming evidence from present and past medical research that circumcision has several health benefits associated with it. As in all surgical procedures there are, of course, some risks attached to it. However, as we will discuss below, these risks can be minimized, and under normal circumstances it is a very safe procedure.

  For most men, however, the real practical benefits are those experienced in everyday life. If you are one of the millions of men that have been circumcised, then ask yourself if your own experience of circumcision agrees with what you have read. In all likelyhood you will say no! And you are not alone: many men have testified about their satisfaction on being circumcised (see the personal testimonies on this site, ICIRC or CIRCLIST (see here for links). For many of these individuals, circumcision is an overwhelmingly positive experience that often was preceded by many years of physical (and sometimes even psychological) suffering which could easily have been avoided.

 

In order to make an informed decision, you might consider the following facts.

Health Benefits

  Medical studies have shown that circumcision greatly reduces the risk of urinary tract infections (UTI), especially in the first year of life. These infections can cause serious problems, especially in infants. For example, UTI can cause scarring of the kidney and ultimately hypertension or kidney failure. To make matters worse, recent studies have shown that UTI are becoming more resistant to anti-biotics, thereby making treatment both much harder and less effective.

  Cancer of the penis is virtually non-existent in circumcised men. Of the 60000 cases reported since the 1930´s, fewer than 10 occurred in circumcised men. The risk of penile cancer in uncircumcised men is 1 case per 400-600 men, while in circumcised men it is 1 case per 75000 to 8 million men [1]. Circumcision also helps to reduce the risk of cervical cancer in female partners. Prostate cancer may also be increased for uncircumcised men.

  Recent research [2],[5] has again confirmed that infant circumcision reduces the risk of contracting sexually transmitted diseases, including HIV.

  Circumcision also eliminates problems like phimosis (intractable foreskin) and balanitis (inflammation of the foreskin). Even though these problems only occur in about 10% of men, they can be very painful if not treated. In older males, phimosis can cause urine blockage with acute hypersensitive kidney damage. Other painful problems that might occur include paraphimosis (where the retracted foreskin cannot be brought back again over the glans) and posthitis (inflammation of the foreskin). Uncircumcised men are often unaware that these problems are all related to the presence of a foreskin, and that the discomfort and pain that they are experiencing are easily treatable. In almost all cases, the only permanent treatment is circumcision.

 
Hygiene Benefits

  Opponents of circumcision often state that the uncircumcised penis can be kept sufficiently clean by just using soap and water. However, what they fail to mention is the fact that the build-up of bacteria that causes smegma and odors starts again immediately after cleaning. Urine further worsens matters. To maintain a sufficient standard of penile hygiene would therefore entail cleaning under the foreskin at least every time after urinating. Everyone knows that in real life this is almost totally impossible to accomplish. E.g., at work most men have to share a restroom with other colleagues, which makes it impossible to indulge in the necessary cleaning activities. At home, frequent cleaning, although possible, is a constant hassle from a time and effort point of view.

  Young boys, especially between the ages of 4-14, are often very water-shy. Getting them to bathe frequently can be a hard task for parents. If maintaining general hygiene is a problem, just imagine how difficult the situation regarding penile hygiene will be. A boy who does not like to bathe is not likely to clean under his foreskin!

  One day your son will be a grown man, and studies have shown that women have a preference for a circumcised penis. The reasons for this are not hard to understand: most women find the circumcised penis more aesthetically pleasing, and a circumcised penis is also cleaner, which makes spontaneous sexual intercourse possible. There are also health benefits by reducing the the risk of transmitting or spreading vaginal (e.g. yeast) infections.

  In an age where the general population in the US and other developed nations is getting older, there has been a steady increase in the number of people who need extended care. In older men, the absence of circumcision can cause various health problems, and cleanliness if often difficult to achieve among those with limited mobility. For those unable to take care of themselves, there often are added emotional problems caused e.g. by the embarrassment of having one's personal cleaning done by another person. It should therefore come as no surprise that most nursing personal that work with extended-care mature men are in favor of circumcision!

 
Sensitivity of the Penis

  The claim that circumcision reduces the sensitivity of the penis, thereby diminishing sexual pleasure for both partners, is one of the most controversial and most hotly debated issues surrounding circumcision. This claim is, however, a complete fallacy for the following reasons.

  There is no scientific evidence that supports this allegation. Remember, the foreskin is not the only erogenous part of the penis! Secondly, men who were circumcised as adults report that sex without a foreskin is totally different, which makes direct comparisons meaningless. What is also interesting, is that these men have testified that for them sex is better than before. A recent study [3] has furthermore shown that circumcised men have more varied sex lives. If circumcision did indeed diminish sexual pleasure, this would hardly be the case!

  The allegation that the foreskin "facilitates" intercourse by being able to slide back and forth is another popular myth that has been refuted by the above-mentioned testimonies: most men have reported just the opposite, namely that the foreskin covers the glans for most of the time, which lessens the sensitivity experienced by the male partner during intercourse.

  The use of condoms, which in the light of the increase in the spread of sexually transmitted diseases has become more important than ever, is far easier if the penis is circumcised, since the foreskin is often in the way, and has to be retracted correctly for the condom to fit properly.

  During circumcison typically 20-50% of the foreskin is removed (depending on the method used) and not the 80% that is often quoted!. If you are worried that too much foreskin might be removed, then the best solution is to talk to the person who will be performing the procedure. Also, circumcision does not shorten the penis!

  It is a great pity that the anti-circumcision lobby deems it necessary to revert to these kind of scare tactics, based on unsubstantiated claims, to dissuade parents rather than providing them with unbiased medically based evidence to support their claims.

The Issue of Pain

  There is no doubt that circumcision without the use of analgesia and/or anesthesia can be painful and uncomfortable to the infant. However, parents can - and should - insist that the person carrying out the circumcision (pediatrician, obstetrician or family doctor) uses some form of pain relief.

  With the use of anesthesia like the dorsal ring block (recommended by the AAP) the operation can be made almost painless. Parents can go one step further by seeing to it that the circumcision is performed by an experienced operator. This will not only reduce the risks involved (which are already very small, see below), but also shorten the time it takes to do the operation (which normally lasts only a few minutes). Being there to comfort your child during the procedure could also help to reduce his discomfort.
 

Pain therefore no longer needs to be an issue when considering circumcision!

Risks: the Safety Issue

  Circumcision is a surgical procedure and, as such, inherently has some risks attached to it. However, it is still one of the safest surgical procedures around. Let us look at some statistics in more detail [4]:

• Significant bleeding is rare: only 1-2 per 1000 performed circumcisions may need pressure to stop bleeding, while 1 in 400 cases will require a stitch to stop the bleeding.
• Serious infections develop in about 1 in 4000 cases. These can usually easily be treated using anti-biotics.
• In the 40 year period 1953-1993, there were three reported infant fatalities due to hemorrhage. However, two of these cases involved circumcision at home by non-medical persons. To further put these statistics into perspective: during the same period, 9,000 - 12,000 men died of penile cancer, and approximately 40-50 million men were circumcised.