A boy being circumcised recently in Algeria. Circumcision practices vary widely across the world. (Fayez Nureldine/Getty Images)Circumcision is the most common surgical procedure performed in the United States. But does it violate the human rights of baby boys?
That’s the provocative question raised this month by The British Medical Journal, which published a debate between two physicians about the benefits, risks and social reasons behind circumcision. Some medical experts view circumcision as a potentially important medical intervention for stopping the spread of AIDS. Last year, a report showed that the procedure appears to reduce a man’s risk of contracting AIDS from heterosexual sex by half.
Around the world, about 30 percent of men are circumcised, and most were circumcised in infancy. Circumcision is more common in English-speaking and Muslim countries. In the United States, about 70 percent of men are circumcised, although rates vary by race and ethnic group, according to a September study in PLoS One. That same study suggested circumcision rates in the United States are on the decline as parents begin to debate the medical vs. cultural reasons for seeking the procedure.
Dr. Geoff Hinchley, a British emergency doctor, notes that most circumcisions take place for religious rather than medical reasons. He also notes that circumcision continues “unchecked” in countries where other rituals, such as female circumcision and facial scarification, have been made illegal.
Dr. Hinchley notes that historically, the medical community has made many unsupported health claims to promote circumcision, including the prevention of penile cancer, masturbation, blindness and insanity. Although he acknowledges recent data showing circumcision lowers risk for H.I.V. transmission, he argues that is an issue for sexually active adults, not children. “The decision about whether to have this procedure should be left until the person is old enough to make his own informed health care choices,” he writes. “The unpalatable truth is that logic and the rights of the child play little part in determining the acceptability of male genital mutilation in our society.”
British physician Dr. Kirsten Patrick argues that the future sexual health benefits justify parents’ choices to have their sons circumcised. Dr. Patrick writes that the pain of circumcision, if done under local anesthesia, is comparable to that from an immunization shot.
She also cites evidence of medical benefit to men and women, noting that circumcised men are less likely than uncircumcised men to have human papillomavirus infection, and that male circumcision is associated with a reduced risk of cervical cancer in women with high-risk sexual partners. A large New Zealand study suggested that uncircumcised men are almost twice as likely to get a sexually transmitted infection.
But Dr. Hinchley counters with a recent study that showed the uncircumcised adult penis is more sensitive than the circumcised penis, largely because the five most sensitive areas are removed during circumcision. “This implies a reduction in future sexual sensitivity for circumcised adults,” he notes. “Far from being a harmless traditional practice, circumcision damages young boys.”
Dr. Patrick disagrees, noting that no good research has examined the long-term psychological effects of male infant circumcision. “Until a large, representative study of sound methodology examines this issue, we cannot know for sure if men who grew up without a foreskin feel that they were assaulted,” she writes. “Only a tiny proportion of the billions of circumcised men have reported emotional distress as a result of it.”
She concludes, “It is far better to help parents to find a competent operator than to force them to navigate the unregulated circumcision services alone, which increases the likelihood of harm. Circumcision is a choice that parents will make on behalf of their male children, for cultural or other reasons, and regulating its provision is the wisest course of action.”
Read the full debate in The British Medical Journal here, as well as responses from BMJ readers on both sides of the issue here.
Finally, I recommend this fascinating post from my colleague John Tierney, who writes about A New Debate on Female Circumcision on the TierneyLab blog.
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From 1 to 25 of 638 Comments
Dr Hinchley is right in noting that male circumcision is a procedure looking for medical support. The prevention of HIV infection may likely prove as specious as all previous ones.
— Paul D. LawrenceDr Patrick is mistaken about long-term psychological effects; it is long term erotic effects. Men who have been circumcised as adults report diminished sexual pleasure.
If female “circumcision” is now called “female genital mutilation,” what does that make male circumcision?
Circumcision, male and female, arose from religious superstition and other outmoded ways of thinking that the 21st Century should confine to the dust bin of history.
Male genital mutiliation, aka circumcision, really gets me angry. Why is there not equal outcry to this barbaric and outdated practice as for FGM? It should be banned and those who insist on mutilating their baby boys for religious, cultural or misguided medical reasons should be prosecuted.
— SharonIt would be interesting to know on what grounds Dr. Hinchley claims to have “standing” to speak for the millions or billions of males when “Only a tiny proportion of the billions of circumcised men have reported emotional distress as a result of it.”
Is Dr. Hinchley himself a “victim” of “male mutilation”, if so, he has every right to speak out for himself. If not, this stinks of a “created problem”.
Or is this some kind of sick joke version of bizarre backlash against the “female mutilation” campaign, in which Western society, which does not practice female circumcision, is somehow blamed for not forcing other cultures to stop the practice?
This practice has been going on in some cultures for literally thousands of years, without noticeable or even reported harm.
I heard of this issue in my expecting father’s class (natural childbirth classes for the Dads)in which the mid-wives, who campaigned against automatic circumcision of male babies, joked that the latest studies showed that maybe they were making the wrong recommendation - uncircumcised males were sexually more sensitive and didn’t have the “staying power” of their circumcised brethren. The joke was, their campaign against male circumcision was creating a generation of “Quick Straw McGraws” contrary to their feminist best interest.
— Kip HansenAs a circumsized male, I can tell you the last thing I need is MORE sexual sensitivity. And I believe every female in the world would agree…
— mikePeople are idiots. Whatever reason can one possibly conjure up for surgical intervention on a new-born in the absence of compelling and immediate medical need? Why not remove the appendix at birth — it sometimes gets infected — or lop off the end of the left little finger as a sign of belonging to an in-group? The practice is primitive, atavistic and repulsive.
— w a garlandIt is absolutely a human rights issue. Nobody has the right to remove an uninjured part of my body without my consent. In my case, my parents weren’t even consulted. The doctor just went ahead and did it without asking. Shame on him! If he were still alive, I’d sue him.
— ngagspaDr. Hinchley is right about sensitivity and quality of orgasm. Men may have no way of knowing how they are different from other men, but as a woman who has had both circumcised and uncircumcised partners, I can attest to the longer and seemingly more powerful orgasms experienced by uncircumcised men. I have asked other woman if they have noticed this difference and all the ones who have had both types of partner concur. From these observations, I have decided to never circumcise my own child. My goodness, Dr. Patrick, why not let the men decide themselves when they are of age?
— KarenI wonder if studies showed that female circumcision was beneficial in preventing certain diseases if Dr. Patrick would recommend it for infant girls? Most men may not feel they have been assaulted by circumcision but they most certainly have been. A painful, unnecessary procedure has been performed on them that has removed healthy, sensitive tissue that has a real function. Whether they like it or not, or admit it or not, the sex act has been diminished for them (although maybe not to the same degree) as it has for circumcised women.
Michael
TPP responds: Here are Dr. Patrick’s comments on the comparison of male circumcision to female circumcision.
— MichaelI couldn’t agree more with Dr. Hinchley, male circumcision is genital mutilation. If the only arguments in favor of circumcision are about sexual activity, then why not wait until a young man is sexually active to allow him to consider what he would like to do with his body?
The same people who will argue until they are blue in the face that abortion is a right because women need to have control over their bodies, will disagree with me when I argue that we should give young men the same control over their bodies.
I’m quite sure that one day, the world will regard circumcision (male and female) as a brutal remnant of history.
— Michael Oman-ReaganIn response to #1, most religious “superstitions” arose out of a societal need. Eating raw pork can kill you, so ancient Jews wrote into the bible that god says “don’t eat pork” (same with shellfish, stealing, killing, etc). Male circumcision as a religious practice arose out of the high incidences of penile infection among babies (and adults) in ancient times.
I actually was coming around to the idea of not circumsizing males, until my best friend told me that when his son was born earlier this year the doctor told him that if he didn’t circumsize his child he would have to clean his penis a few times a day until he was three years old with alcohol and cotton swab. To me that is more traumatic
— mikeCircumcision is an invasive medical procedure, period, full stop, end of story. In the absence of any compelling medical indication that requires its use, it is unwarranted. Indeed, it is a barbaric practice whose time has long since passed.
— KenIsn’t it crueler to neglect to circumcize your infant and subject him to the pain he will feel when he has the procedure done as an adult?
— SiviyoTPP responds — just because they are babies doesn’t mean it hurts any less. They just can’t tell you about it.
Male circumcision is a brutal, barbaric practice that began as a religious ritual and was later “defended” by dubious medical studies, including the most recent one. Claiming a lack of “good research on the long-term effects” is as absurd as saying blindness may not be a liability, given that people blind from birth have no idea what it means to be sighted, while “only a tiny proportion” of sighted people lose their vision. I agree with the previous poster who said that doctors who perform this ritual should be prosecuted. “Do no harm” is supposed to the primary concern of doctors. How can mutilating an infant even be considered by so-called civilized society?
— TomTwo or three posters (as well as Dr. Hinchley) have suggested that while circumcision may allow for safer sex (for both men and women), parents should stay out of it and allow their boys to make their own decisions when they reach sexual maturity.
— HollyI respect your opinions about circumsision, but what are the odds, do you think, of a 14 or 15 year-old boy deciding to opt for surgery when boys/teens/men are often loathe to even wear a condom–a device which could easily protect both parties from STDs and pregnancy? It doesn’t seem realistic to think that a teen will inconvenience himself to such an extent in order to protect his (or the girl’s) health. So if there is indeed validity to the protective value of circumcision (more on this in the years to come, I’m sure), perhaps it makes sense for the parents to make the choice themselves during the child’s infancy.
FGM results in women having extreme pain for their entire lives. It can take them 15-20 minutes just to urinate. Circumcised males suffer no such pains.
There is a huge huge huge difference between the techniques…men are not sew up the way women are.
— BCThe practice of the circumcision of children must end. Some things are wrong absolutely despite being a common practice in some cultures. Removing a healthy body part before a person can consent to it is absolutely wrong despite being an accepted practice in the Mohammaden community. Would we be so silent if the practice was to remove the pinky instead?
— Jack StrawI am the mother of 3 sons, all uncircumcised. My first son born in 1980, when it was unheard of for a white middle class boy not to be. I educated his father to assuage the “looks like me” myth as valuable and valid reason to have a circumcision done.
I can’t imagine how violated men feel to have had this done as an infant, I wanted to make sure it was my son’s choice. It turns out it was the best decision I made as a young mother.
— AndreaNo mention of how many botched male circumcisions there are? It is an unnecessary, “cosmetic” surgery that makes no sense. I find it ironic that Dr. Patrick, who has never had a foreskin, can be such an advocate for their removal.
— homerMike, nice defense mechanism! Many circumcised women defend their circumcisions as well.
As a circumsized male, I can tell you the last thing I need is MORE sexual sensitivity. And I believe every female in the world would agree…
— Posted by mike
— MichaelI question that 30% of males are circumcised. From studies which I have seen I believe it is more like 20%. If one took a random sample of males worldwide, my impression is that, out of 25 males, 20 would be uncircumcised, five would (or will be, as some social groups circumcise later than at birth) be circumcised. Of these five, four would be Muslim and one would be American.
— John MilemIt would be interesting to know what proportion or circumcised males were circumcised as infants. My guess is that a majority of circumcised males in the world were not circumcised as infants. I believe that in Muslim tradition circumcision was done around puberty.
I have been amazed at the ignorance parents generally seem to have about circumcision. I have yet to find parents who were asked if they wanted a tight or loose circumcision, if they wanted a high or low circumcision, if they wanted the frenulum excised or retained. I have been amazed at the number of Christian Americans who take for granted that since Jesus was circumcised, it’s a good thing for their boys to be circumcised, without any understanding that in America we remove the entire foreskin or, in the case of a high circumcision, a compensating amount of shaft skin, whereas it was not until the Bar Kochba rebellion, more than a century after Jesus, that some Jewish rabbis instituted the removal of the entire foreskin to make it harder for Jewish boys to pass as uncircumcised.
As an STD epidemiologist concerned with bioethics I feel compelled to acknowledge both the protection against HIV acquisition conferred by circumcision and the onus on health practitioners to avoid unnecessary surgery on infants.
Routine circumcision is performed on healthy tissue and affects the sexuality of the adult male an infant becomes, without the consent of that adult. Under these circumstances, compelling reasons would required to perform the surgery. Birth into a country where 25% of the populace is HIV infected would be such a reason. The folk traditions of the parents would not.
— Edward WhiteAs per comments below from the BMJ: It can most certainly be compared, everything listed below can be applied to male circumcision. Just because it may not be as severe is beside the point. A society that routinely lops off two toes as opposed to three is no less barbaric.
TPP responds: Here are Dr. Patrick’s comments on the comparison of male circumcision to female circumcision.
It cannot be compared with female circumcision, which has been shown to be no more than genital mutilation without medical benefit and with an unacceptably high likelihood of pain, immediate and long term medical complications, and psychosexual scarring. — From the BMJ
— MichaelAs a circumsized adult male, I am grateful for the decision made by my parents to have me circumsized - especially in view of what seems to be unequivocal AIDS prevention & other benefits. Waiting until a child was 18 and then giving them the option would almost certainly doom millions to HIV infection (heck people don’t even save in employer matched 401ks if just given the option - whats the odds a hormone loaded teen will agree to a painful procedure that might reduce sexual sensations??) As for the latter point, having never had the parts of my foreskin with the pleasure receptors which were removed, I can only say, I enjoy sex just fine, thank you & given the rates of teen sex and unwanted pregnancies, do we REALLY want to make it even more enjoyable anyway??
— Artful DodgerThose who say that male circumcision is safe, are misinformed. It is safe over 99% of the time. Would you like your son to be the 1 out of 10,000 (or whatever it is statistically) whose penis ends up being amputated in the course of male circumsicion? Case closed.
Female circumcision is or should be viewed as a crime against humanity — similar to chattel slavery, enforced prostitution, genocide, cannibalism, human sacrifice, euthanasia, infanticide, corruption of children, etc.
Therefore it is very appropriate for outsiders to step in and stop this practice wherever it is found. On the other hand, for adults to do this of their own choice is another matter. I myself would argue that self-mutilation, and sale / purchuse / cultivation of substances known to be harmful, should be outlawed. But if it they are not outlawed, the laws must ensure that they are only practiced by citizens who are educated and not under any kind of compulsion, whether economic, physical, social, religious, or whatever.
In addition to the welfare of the individual person, the society has another stake in the matter: namely, that persons who are mutilated or harmed — whether by themselves or by others — may well end up as wards of the state to one degree or another.
— John LaneThe real reason circumcision was pushed in this country is so that jewish boys don’t look any different in the locker room.
Can anyone really rule this out as a possibility? Makes sense to me (and I’m Jewish).
— pip