Thursday, June 19, 2014

Circumcision Q&A: A follow-up to “Why Not”

In THIS article, my wife and I gave some background on our own journey through making the decision whether or not to circumcise our future boys. In addition to some feedback and discussion in that post, there have been some more questions and discussion points come up and I feel like these present a great opportunity for discussing this seeming “hot topic” in a way that isn’t contentious. The following are paraphrased from actual questions and comments, with answers and open-ended questions to encourage further dialog and consideration.

“What about emergency circumcisions? Wouldn’t boys/men who have to have these emergency procedures have been better off if they had been circumcised at birth? We could spare them this medical trauma later in life by circumcising them now.”

Do you really think that sparing them from a “potential” medical trauma later justifies putting them through a certain medical trauma now? Are you aware of how traumatic circumcision is to an infant? Have you witnessed or read about the process of stripping the membrane that attaches the foreskin to the head of the glans?* What about the fact that circumcision is the only surgery in which the post-op “bandage” is a urine-soaked and feces-filled diaper?

And what about the actual function of the foreskin? Are you saying that it’s better to deprive a man the function of his foreskin so that he can be spared a theoretical trauma that he is almost certainly never going to experience, and if he does, can be treated non-surgically?

While I empathize with the theoretical cases, there are no studies which show that circumcision is actually necessary to treat any condition of the penis. The conditions you will find related to the penis involve infections due to poor hygiene, unwarranted retraction of foreskin that is not ready to be retracted, and the like. What you will also find is that these conditions can be treated with topical ointments or antibiotics, or can be prevented by proper hygiene and education about proper foreskin care. And wouldn’t you agree that the rare instances of these traumas (what percent of the male population are we talking about annually, after all…with cited source please) don’t really justify the routine circumcision of nearly 40% of the boys born in the US today (more than that, according to some websites which advocate FOR circumcision)? Don’t you agree that it would be better to teach Americans about proper penis care so that we can help prevent these rare traumas in the first place? Don’t you also agree that the lack of problems in other countries with an overwhelming percentage of intact males indicates that this is just an American problem and that we need to find a more effective way to deal with it?

It is frivolous at best, and harmful and inhumane in reality, to “pre-treat” such a large number of people for a medical condition they will likely never experience, and for a condition which could be treated or prevented by other, non-surgical, means. Yet you are proposing to traumatize the general population of male infants in order to prevent a miniscule number of them from going through a supposed future trauma which can be prevented by proper hygiene or treated non-surgically. By leaving them intact, we can spare the infants this trauma now, and treat them humanely later if they need any treatment. Doesn’t that sound like the better option?

“Many sources say that infants are sent home within 24 hours after the procedure. This means that they are pretty much healed, right?”

Most of the research I’ve looked at suggests 5-10 days for healing, despite sending the child home after 24 hours, and many of the young boys I know of who were circumcised at or near birth took even longer than that to heal. Here are some pro-circumcision and neutral sites that I grabbed in order of appearance during a random google-search for “circumcision healing time”: - “5-7days” “a week” (pro-circ doctor advertising his services) “10 – 14 days” or “three to seven [depending on the procedure]” ( pro-circ site) “about a week… up to three weeks [for older children]” “5-7 days…7-10 days…up to 3 weeks”

Being sent home from the hospital doesn’t mean the wound is healed. The wound takes several days to heal, and during that time the child is in pain, with no anesthetic to stop the pain. And what is this child suffering for? For an “aesthetic” reason in which he had no say? To “pre-treat” a medical condition that he was likely never going to experience in the first place, and could have been treated with cortisone cream, or that can be prevented by proper hygiene? What’s the purpose?

“Infants are given anesthesia for the procedure, so they don’t feel the pain as much, even if it is somewhat painful. In light of those who would have to be circumcised later in life due to emergencies, doesn’t it seem appropriate to do a preventative procedure that has the benefit of anesthesia?”

Are you assuming that all circumcised boys receive anesthesia? Some doctors don't give it unless the parents request it. Though I would hope this would be the exception.

Again, there is no male "who would have to be circumcised later in life due to emergencies". If urine can exit the penis, there is no emergency. The rare so-called “emergency” conditions related to the penis, for which circumcision is being suggested as a "treatment", are typically treated with topical ointments, antibiotics, and proper hygiene. If these conditions can be treated non-surgically, it makes me wonder why any doctor would recommend circumcision. Don't you think it seems strange that a doctor would resort to removal of the foreskin when it could be treated otherwise? Why do you suppose a doctor would do such a thing? My guess is that it's the same reason a doctor might schedule a c-section for a baby who could just as well be born naturally, even though it may take a few extra hours of labor.

The anesthetics that numb the pain don’t block it out completely. If you have doubts about this, please do an internet search for “videos of circumcision” and tell me whether you think those baby boys are feeling some pain. I believe you will come away with a new perspective about that.

The anesthetics also don’t last very long. So, while the baby is at home healing for up to 3 weeks, he is still feeling pain, yet has no anesthetic for pain relief other than what mom or dad can find over the counter (which aren’t very effective in my experience). I would guess that this is why baby boys cry when their parents are cleaning the wound and changing diapers. Wouldn’t you agree that, even if all pain was completely blocked out, this is not a justification for cutting off every newborn boy’s foreskin? Wouldn’t you agree that, since no studies show circumcision to be necessary, it would be redundant at best, or harmful at worst to force the procedure on ANY baby boy? If only a small fraction* of the male population will have a medical condition related to his penis, and the recommended treatments for such conditions are topical ointments, antibiotics, or proper hygiene, then why are we wanting to circumcise all of them?

*For perspective, one of the more common diseases that the medical world felt worthy of being published was the average incidence of UTI’s in intact boys in the 1980’s**. Despite the numbers being skewed and the fact that the evidence proved that NOT circumcising would REDUCE the incidence of infant UTI’s, the number was still only about 0.2%. So what percent of the male population is having these medical emergencies that supposedly "require circumcision" as the primary treatment/cure of the condition, where non-surgical treatments, hygiene or proper penis care would not have worked? I bet it is less than 0.2%.
** Circumstitions: Circumcision and UTI's

“My young boy was thankful for having been circumcised after we explained to him what the foreskin is and explained/showed what a penis looks like with foreskin. He was glad he didn’t look like that.”

My own son is happy to have his foreskin and glad that we didn’t cut off part of his penis. But neither of these personal testimonies serves as justification for any medical procedure, one way or the other, don’t you agree? I highly doubt that any child would respond with gratitude after learning that the natural antibiotic and lubricating function of his penis had been needlessly removed, unless these things had been portrayed to him in anything other than a positive way.

Doesn’t it make sense that our children will take cues from their parents in how they view themselves and others? Perhaps if we give our children ALL the facts and allow them to make a decision about their bodies when they are mature enough to comprehend those things, we might surprise ourselves. In the meantime, I don’t see how a young boy can look at his own penis and come to a conclusion that he is happy to have part of it removed unless his parents have taught him to see that part of it in a negative way. Or do you think that children are pre-programmed to make objective observations about themselves that would lead them to see part of themselves as being ugly or useless or disposable? I find that hard to believe given the number of children that want to even keep their “nose-nuggetss”, scabs, nail trimmings, baby teeth, etc… My experience and observation with children is that they see EVERY part of them as being a valuable part of them, unless someone has told them otherwise.

“Since STD’s are occurring more in men with foreskin, and we live in a promiscuous society, it makes sense to have males circumcised at birth. After all, they are just going to have sex anyway.”

The whole STD argument is a red-herring and a non sequitur. It's a red-herring because foreskin is not a cause of STD's, nor is circumcision a potential cure or effective means of preventing the spread of STD's. It's a non-sequitur because it does not follow that keeping or removing the foreskin will have any effect on STD's or on the acutal cause of the spread of STD's. I don’t see this as being any different from when someone tried to pin UTI’s on intact males…which turned out to prove the exact opposite of what that person intended (see **link above).

The data on STD’s and intact-ness, if any of it can be relied upon, is skewed in light of the recent trend upwards in intact males along with simultaneous trend upwards in a sexually promiscuous society. Circumcision will not prevent STD’s.* If you think it will, I challenge you to research the rates of STD’s in circumcised males. The fact is, if you find ANY circumcised males with STD’s, you have just proven the opposite of what you intended to claim. Circumcision does not prevent STD’s (but abstinence and marital chastity can!).
*Circumcision and Sexually Transmitted Diseases

Does it really make sense to try and solve the sexual promiscuity problem by removing a boy’s foreskin? Why would anyone remove the foreskin in some “effort” to prevent STD’s when the cause of STD’s is extra-marital sex? Does circumcision reduce the incidence of extra-marital sex? I would love to see a study that looks at that, but I don’t think such a study exists.

Extra-marital sex is what leads to STD’s. So wouldn’t it make more sense to teach our children not to have extramarital sex? Doesn’t it make more sense to teach our children not to be promiscuous and expect them to exercise self-control? Or should we simply accept that humans no longer have the ability to control themselves and therefore should not be held accountable for their choices? I don’t believe that for one moment…and I don’t think you do either, am I right?

In summary, there is no good reason for a general circumcision of all baby boys. It's a painful and needless procedure that has no logical basis when put under scrutiny. It isn’t “necessary” in the religious perspective unless you are Jewish or Muslim.

It isn’t medically necessary, not even for the minuscule percentage of males who experience "emergency conditions", because those cases could either be treated by topical ointments/antibiotics or could have been prevented by proper hygiene and proper penis-care/education. Even in some of those remote instances, circumcised males experience the same conditions just as often (balanitis, for example, which is attributed to poor hygiene).

The superficial reasons, such as “aesthetics”, are subjective and certainly don’t justify a general mass-circumcision and don’t take into account what the child would want, otherwise the procedure would be postponed until the child is old enough to make that decision for himself.

And the arguments that circumcision is not an amputation or impairment of an organ don’t hold up when talking about the current, modern procedure of circumcision.

There is simply no good reason for it that could not wait until the child matures enough to make that decision on his own.


  1. A study (published 11/9/2012 in the Journal of Sexual Medicine) in the Caribbean has shown that circumcised men actually were more likely to have had a Sexually Transmitted Infection (STI), genital warts (HPV), and be infected with HIV.

  2. "Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: Methodological, ethical and legal concerns" by Gregory J Boyle and George Hill

    "The trial was stopped early because of futility. 92 couples in the intervention group [circumcised partner] and 67 couples in the control group [intact partner] were included in the modified ITT analysis. 17 (18%) women in the intervention group and eight (12%) women in the control group acquired HIV during follow-up (p=0.36). Cumulative probabilities of female HIV infection at 24 months were 21.7% (95% CI 12.7-33.4) in the intervention group and 13.4% (6.7-25. in the control group (adjusted hazard ratio 1.49, 95% CI 0.62-3.57; p=0.368)."

    Where circumcision doesn't prevent HIV:

  3. A friend brought this up recently, and the recent decision of CDC to support and promote circumcision was discussed. Here's a paraphrase of some of that:

    On December 2, 2014, a news release was published by ABC news that the CDC had suddenly come out in support of routine infant circumcision (RIC). It appears, from the message in the release, that it's a reaction to a decreasing trend in RIC in the US.
    Here's that report:

    They toss it right back to the STD argument, which is a classic "false cause" fallacy. (Foreskin doesn't cause STD's, and removing it doesn't prevent STD's. Though, abstaining from extra-marital sex CAN prevent them. ;-) )

    Anyway, it makes me wonder why they'd be blowing the trumpet for RIC when no study has ever shown it to be medically necessary. That's when I stumbled up on these little gems:

    Things that make you go, "hmmmmmm".