Mutilation? Protection? Tradition? Ignorance?
Published on April 7, 2007 By JamesSerral In Health & Medicine

What do you really know about circumcision? You may have heard of health benefits, but what are they and how important are they? Are they important enough to not give your son a choice? What do you really know about an intact penis? After finding out as much information as I could, I am against the procedure, but I will attempt to give you an unbiased (as much as possible), balanced, perspective on circumcision. This might get kinda long, there is a Summary section at the end if you want a quick read.

My interest started as simple curiosity on why circumcision is performed no one really says why... and after seeing the American Academy of Pediatrics statement about circumcision:

"Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision."

.... and that Canada, Australia, New Zealand, Denmark, the UK, and many other countries have circumcision rates of around 15% or lower I began to wonder why it is so prevalent in the US. I had heard there were medical reasons for it being done, but if they are not "sufficient" then why does it seem it is it pushed so much? This led me to do more research and find out all I could on the subject. Although I have been following this topic closely, I never really thought to blog about it till now. Hopefully, at the very least, by reading this you will actually think about the procedure and do your own research when making a decision and not just go off preconceived notions. If you are cut/uncut hopefully this will give you a better perspective on why you are the way you are. Keep in mind if you do additional research, this is a heated topic and you will find extremely biased information all over the place.

HIV and STDs

I will first start with the more recent HIV claim. A study in South Africa reported around a 50% higher chance (1 in 30 intact infected compared to 1 in 63 cut infected or 56 circs to prevent 1 HIV infection) of getting HIV when uncircumcised through vaginal heterosexual sex (where the woman carried HIV). This study is fairly controversial, partially because of the Cochrane 2003 study in Africa that found conflicting evidence on the true prevention and accuracy of data recorded there due to cultural customs, not to mention the extremely specific requirements (heterosexual, vaginal intercourse, where the female carries HIV). Another reason this is controversial is male -> female infection rate is much higher then female -> male and there is no signs that circ would protect women, some thing it might actually be worse. The males that were cut required a period of abstinence, while uncut males could continue so the actual study didn't start on the groups at the same time, AND the study was terminated early (due to the odd results, which strangely enough, they are still spouted as reason to circumcise). The 4 leading doctors on supervising the study were all supporters of circumcision, allowing for more bias, not to mention the cultural bias from being from the US which could influence the results.

However, for argument's sake, lets say circ DID reduce chances of getting HIV from hetero-vaginal sex by 50%, now if this was true, why would the US have the highest HIV infection rate? Clearly, this is not what needs to be changed to stop HIV from spreading. HIV can be transfered other ways as well, male -> female heterosexual vaginal sex, hetro and homo anal sex, needle sharing, blood transfusions, mother -> child, and other ways. Telling men that by being cut it is much harder to get HIV and other STDs can actually have a negative backlash because they will think they don't have to worry about it.

Despite what you hear about homosexual/bisexual anal sex being more dangerous then heterosexual sex due to the more fragile anus, a study in 2001 revealed a 1.1% greater chance of getting infected with homosexual anal sex if you were circumcised, although a minute difference it is radically different then the study in Africa and supposeably with a more easily infected group. Although I couldn't find any arguments, perhaps that study is biased too, however it just reinforces that Safe sex practices are what should advocated for HIV/STD prevention, they have a much, MUCH, higher chance of protection then circumcision has ever claimed, even ones as controversial as this. If an uncut man was given the choice between a condom for almost assured protection or circumcising for a 1 in 56 chance of protection I think the answer is clear.

UTIs

Luckily, the % chance of UTI is is much less controversial then the HIV studies due to the larger amount of research. So, how important is the reduction in UTIs? Lets crunch some numbers. (there is a slight variance in research so I will figure for the high/low % for what I found)

In the first year of life the chance for circ infant is around .1%-.2% or 1 in 1000-500, an uncirc infant has around a .4%-1% chance or 1 in 250-100. (as a side note, girls still have a 2-3 times higher chance of getting a UTI then an uncirc boy) So an median of 183 infants must be circumcised to prevent 1 UTI. At this point you may be thinking, that isn't a very high chance for something that is cureable with medicine, or perhaps you like the odds of not having to worry about it, however, consider this.... there is a 2-10% complication rate for circumcisions, bleeding, infection, skin bridges, etc... so out of the 183 that were circ to prevent that 1 UTI 3-18 have complications, these are not fatal and can be taken care of, but so can UTIs... so I dont see how this is a good reason especially since girls have a much higher chance of UTIs and medication work fine for them.

Penile Cancer

Penile cancer is rare and occurs most often in elderly men. The actual risk is a bit controversial, however, from the NCI, to prevent 1 case of penile cancer, about 1000 circs must be performed. If you are interested in actual deaths, depending on when it is caught, it has a median 20% mortality rate (1 death for 5000 circs). Is it worth it to deny your son a choice? I dont think so, breast cancer in males is more common and causes more deaths then penile cancer. Out of 766,860 reports of cancer in males, only 1280 were Penile Cancer (possibly a bit misleading since Penile cancer was grouped with all other male genital cancers that weren't in the testis/prostate.) So that means out of all the cancers a male can get, only .167% will be penile cancer (that is assuming ALL cases were penile cancer) of which, .033% will die from. NOTE: that is the chance compared with other cancers, while only 1 in 100,000 men in developed countries will get it. From these already tiny percentages about 75%+- will be uncirc males. Oddly enough, there were more cases of cancer in the eye, then the penis....

That said, although penile cancer is more deadly and scary sounding then UTIs, it is so rare I don't think it warrants circumcision. Safe sex practices and good hygiene are much more important and actually would also help prevent penile cancer since getting HPV (human papilloma virus) increases your chances of penile cancer.... there is also now a vaccine for many types of HPV called Gardasil.

Hygeine

The main thing argued here is about smegma and an environment for bacteria growth. If not washed and allowed to build up it smells and provides a favorable area for bacteria growth (such as balantitis). Both males/females produce smegma (in females it accumulates around the clitoral hood), but so long the area is washed there will be little problem with hygiene. I don't think this warrants circumcision.. sure you dont really have to do anything special being cut, but it isn't like the smegma it is that hard to clean during a shower, pull the skin back, clean with water and your done (some say using soap depletes natural skin oils, so just warm water is fine). Some might prefer the area to be rinsed before oral sex if smegma is built up (male/female).

Appearance

This comes up many times, but it is so subjective from person to person, culture to culture, I don't think it is really a good basis for a decision. However, lets say you like the idea of circumcision because you prefer how it looks compared to the "ant-eater", ok great, that is your preference, BUT that may not be what your child or his partner prefers, and if it IS, wouldn't it be better to let him have a choice? Yes, circumcision as adult is more expensive, but pain is much easier to control then in an infant, AND the man got to choose what he wanted to do... If circumcised as an infant and he wanted to be uncut, well to bad, he is stuck the way he is, the only option he has is foreskin restoration which could take years and never replaces all that was removed.

Sensitivity

Another one that is a bit controversial. Technically, the intact penis should be more sensitive. The glans is suppose to be internal, protected by the foreskin, in circumcised men, it slowly builds up a "resistance" to everyday contact against things such as underwear, blankets, and becomes less sensitive. The decrease in sensitivity slowly happens over time. For this reason, you will hear about studies with uncut men that were cut as adults and don't mind since the glans is still "fresh" and could take years to build up resistance. That said, how many cut men aren't able to enjoy sex as much or even some that have difficulty reaching orgasm because of the decreased sensitivity? Aside from the glans, various other things could influence the studies, masturbation/sex techniques, amount of loose skin, etc, etc

Even with technique and "equipment" differences, the problem with talking about sensitivity and the studies that come from them is that sexual pleasure is subjective, it incorporates physical, psychological and emotional components... will an cut man feel much difference in physical pleasure? Probably, but psychological and emotional feelings could make up for it and since he has never known anything different still enjoys it. On the flip side, what if an uncut man felt less psychological pleasure because he wanted to be cut... at least he has a choice, what if a cut man wanted to be uncut?

Sensitivity may be subjective, but there are no reasons here that would say sensitivity is better... for either partner, so I would again have to say the man should have a choice.

Money

Some have said hospitals enjoy the extra income from a procedure that is done when nothing is actually requiring the procedure.... which could be true and they may not be to keen on a lowering circ rate, but I would hope they wouldn't go to the extent of creating misleading studies and statistics.

Pain

Anyone who thinks infants wont feel the pain have never seen one being circumcised before. Even with anesthesia (which commonly isn't administered), pain is felt since you must be careful on how much anesthesia is administered. If you do decide for circ, please request anesthesia to help with the pain. I think you should also watch the procedure being done, before the procedure and during your own son's. There is a video available, but of course, it is extremely graphic, http://www.intact.ca/video.html Some argue anesthesia is now used so the video is inaccurate. However, only around 50%-60% of doctors actually use anesthesia, of which, a weaker topical anesthesia is is applied and in the cases that due use more powerful anesthesia the amount given is limited due to the danger of anesthesia on an infant, so in most cases pain cant be removed... even if called "routine" it is still an amputation.

Some people have compared vaccines to circ... sure they both may hurt, but someone that argues this is just trying to grasp on to some reason circ is ok.... they think that since vaccines are ok and they are preventative, circ should be ok too? They seem to fail to realize that circ permanently removes part of the body.

Summary

Circ Advantages
- Go from a .7% chance of UTI to .15% in the first year of life
- Reduction in the chance of Penile Cancer
- Easier to clean
- Although still unclear and controversial, a possible reduction in the chance of getting HIV/STDs

Intact Advantages
- No painful surgery when an infant
- "Gliding action" to cause less "rawing" friction to partner
- If the man wants circed he can be that way
- Have a more sensitive penis
NOTE: A more sensitive penis does not mean he wont be able to "last" as long, remember there are psychological and emotion elements as well as self control. Also, even if that was the case, circumcising so your son so he can last a bit longer is a horrible reason to do it.... if anything that should be something your son and his partner should decide... though im sure there are better options then circ.

Things to keep in mind
- UTIs can be treated with medicine and infant girls still have a higher chance of UTIs then uncirced infants.
- Penile cancer is rare and will only be .167% of all the cancers a male can get.
- An uncirc penis is still easy to clean
- Even if true, the HIV study only helps men, not infants, that are old enough to decide if they want to be circed and receive this potential benefit. Circ is not a replacement for responsible sex, even with the reduction, it can only take 1 time to get infected. Condom for nearly assured protection or circ for 1-56 chance?
- If the man wanted to be left intact he has no choice, all he can do is foreskin restoration which still cant get back everything and takes years
- If cut to tightly, maybe even with painful erections, the man will need to "restore" new skin which could take months until there is enough slack skin.
- Like being cut to tight, if the foreskin is tight (phimosis) stretching will need to be done to prevent problems.
- Retracting and cleaning foreskin/glans need to be done to keep clean (NOTE: An infant's foreskin should not be retracted for cleaning, doing so will cause damage to the glans, the foreskin will naturally detach itself, possibly not detaching until puberty.)
- Your sexual preference has nothing to do with what your son or is partner may want, circumcision rates in the US is down to nearly 50%, so give him a choice.

Ethics

Well, I already touched on this a bit, but when does it become acceptable to take the person's choice away? When it becomes the norm of a culture? When you want your child to have that extra protection against disease as substitute for responsible sex? When you don't want your child to worry about good hygiene? It is up to you when and if you feel it is acceptable, I just ask you do more then go with preconceived notions and controversial studies when making a decision and if you are unsure, error on the side of choice.

References

http://www.circumstraint.com
http://en.wikipedia.org/wiki/Circumcision
http://en.wikipedia.org/wiki/Foreskin_restoration
http://en.wikipedia.org/wiki/Gardasil
http://familydoctor.org/042.xml
http://sexuality.about.com/od/malesexualhealth/a/sexcircumcised2.htm
http://www.cancer.gov/cancertopics/pdq/treatment/penile/healthprofessional
http://www.circinfo.net/
http://www.circumcision.org/hiv.htm
http://www.cirp.org/library/disease/HIV/cochrane2003/
http://www.intact.ca/video.html
http://www.sigmaresearch.org.uk/downloads/report02d.pdf


Comments
on Apr 07, 2007
NCI LINK

"Penile cancer is rare in most developed nations, including the United States, where the rate is less than 1 per 100,000 men per year." - NCI

I usually avoid medical "controversies" on JoeUser like the plague, but I had to respond in this instance. Thank you for an otherwise excellent and well-researched article, James. Appreciated it. - Don
on Apr 07, 2007
Well, it's too late for me...my foreskin has fallen by the wayside a long time ago.

~Zoo
on Apr 07, 2007
If the topic truly interests you, here are the links...

"Does God Want You to Mutilate Your Baby?" Link
"Circumcision, Part 2" Link


Thanks for the links, I didn't cover the religious side so anyone curious on that should check out the first link.

I usually avoid medical "controversies" on JoeUser like the plague, but I had to respond in this instance. Thank you for an otherwise excellent and well-researched article, James. Appreciated it. - Don


Thanks for the NCI link, what I had in the article was comparing penile cancer's frequency to other cancers in the male, I left out how rare it is for a man to get as a whole... updated

Well, it's too late for me...my foreskin has fallen by the wayside a long time ago.


So, im going to play psychiatrist and ask, "how does that make you feel?" Whats done is done... I still enjoy sex... without lube masturbation is not that pleasurable, but lube is easy to come by... something like that?

I guess it is probably easier to be happy with what you have when you never knew the difference, it was taken before you became "attached" to it, what you have still "works", and many of those around you are the same way causing it to be seen as "normal".
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