Should Men Be Circumcised?
Dr. Justin J. Lehmiller Posted on Monday, March 5, 2012 at 8:00AM 
In the not too distant past, circumcision (i.e., surgical removal of the foreskin from a penis) was a routine procedure performed on virtually all infant boys in the United States. However, circumcision has become increasingly controversial in recent years and the number of parents opting to perform this procedure on their male children has dropped considerably. The Centers for Disease Control currently estimates that 55-57% of newborn boys in the U.S. are circumcised.1 The percentages differ greatly around the world, with higher rates in the Middle East and lower rates in Europe. So is circumcision a good idea? Unfortunately, there is not a definitive scientific answer to this question. Thus, the goal of this article is not to advocate one position or another, but rather to present you with some different perspectives and allow you to come to your own conclusions.
One of the arguments in favor of circumcision is that it frequently serves religious and cultural purposes. For instance, this procedure is commonplace in the Jewish religion, where it has a basis in scripture and is performed during a bris eight days after a male birth. Circumcision is frequently practiced in Muslim cultures as well, although as opposed to occurring in infancy, it is typically performed at puberty as a rite of passage.
The other major argument in favor of removing foreskin from the penis is that it provides hygienic and health benefits. For example, circumcision is a medical treatment for certain conditions, such as phimosis. Phimosis occurs when the foreskin is too tight and is not easily retracted, thereby creating pain and discomfort during sexual activity. In addition, circumcision is linked to a reduced risk of contracting sexually transmitted infections, including HIV. In fact, a clinical trial in Africa in which adult men were either circumcised or not (on a voluntarily basis, of course) had to be called off because the rate of contracting HIV was so much lower among circumcised men that ethical concerns were raised about withholding circumcision from men who still had their foreskin!2 Other studies have shown that circumcision is linked to a reduced risk of contracting HPV3 and syphilis,4 as well as a lower likelihood of developing penile cancer.5 All of this research, combined with a low rate of side effects and no definitive evidence of reduced sexual satisfaction in adulthood, have resulted in significant support for circumcision within many corners of the medical community.
On the other hand, there are some who argue that circumcision should almost never be performed unless there is a true medical need and that routine circumcision amounts to nothing more than male genital mutilation. One of the common arguments on this side is that everyone has the right to an intact body, and that includes their sexual organs.6 As a result, it is seen as cruel to irreversibly modify another person’s body, especially when they cannot consent to the procedure themselves. Likewise, others have focused on the pain and trauma that circumcision is likely to cause those who undergo it, given that anesthetics are not always used (particularly when the procedure occurs as part of a religious or cultural ritual). Yet one additional argument is that if delaying circumcision until adulthood can still yield health benefits, such as reducing HIV risk,2 why not let men evaluate the pros and cons themselves when they are old enough to comprehend them so that they can decide whether they actually want the procedure?
As you can see, there are compelling arguments on both sides of this issue that make it difficult to state whether circumcision is categorically good or bad. The important thing here is to educate yourself about the different perspectives so that if and when the time comes for you to decide whether circumcision is appropriate for your own child, you are prepared to do so.
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1Centers for Disease Control and Prevention. (2011). Trends in in-hospital newborn male circumcision --- United States, 1999--2010. Retrieved from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6034a4.htm?s_cid=mm6034a4_w
2Roehr, B. (2007). Dramatic drop in HIV infections halts circumcision trials. British Medical Journal, 334, 11. doi: 10.1136/bmj.39073.473634.DB
3Larke, N., Thomas, S. L., Dos Santos Silva, I., & Weiss, H. A. (2011). Male circumcision and human papillomavirus infection in men: A systematic review and meta-analysis. Journal of Infectious Diseases, 204, 1375–90. doi: 10.1093/infdis/jir523
4Weiss, H. A., Thomas, S. L., Munabi, S. K., & Hayes, R. J. (2006). Male circumcision and risk of syphilis, chancroid, and genital herpes: A systematic review and meta‐analysis. Sexually Transmitted Infections, 82, 101–9. doi: 10.1136/sti.2005.017442
5Larke, N. L., Thomas, S. L., Dos Santos Silva, I., & Weiss, H. A. (2011). Male circumcision and penile cancer: A systematic review and meta-analysis. Cancer Causes Control, 22, 1097–110. doi: 10.1007/s10552-011-9785-9
6Hammond, T. (1999). A preliminary poll of men circumcised in infancy or childhood. British Journal of Urology International, 83(Suppl. 1), 85–92. doi:10.1046/j.1464-410x.1999.0830s1085.x
Image Source: http://i184.photobucket.com/albums/x44/Positivemom/anti-circumcision/24324_1387739606558_1024096079_3120.jpg
Reader Comments (9)
"Should men be circumcised?" That's up to the men. Very few men choose it - an excellent reason for leaving babies alone.
Actually, the USA is the only developed country in the world where a majority of babies are circumcised. Non-religious infant circumcision is not just "lower" in Western Europe (or the rest of the English-speaking world), it is virtually zero, and the high rate in the Middle East is because of Islam.
Beware of claims that circumcision "reduces the rate" of this or that disease. From what, to what? It would take well over 100 circumcisions to prevent one urinary tract infection, thousands to prevent one penile cancer.
Interesting that Helen Weiss co-authored half of your references. She and a handful of associates are almost entirely responsible for the recent flurry of claims that circumcision is the best thing since sliced, um, bread. This is not a subject about which people are rational.
Circumcision is not without risk. A baby can only afford to lose 35ml (two tablespoons) of blood before he is in danger, there is a tiny artery near the site, and disposable diapers can easily conceal that much blood. Any small mistake is magnified, and sexual consequences may not become known before adulthood.
Is "no definitive evidence of reduced sexual satisfaction in adulthood" enough to allow cutting a healthy part of the genitals off a baby? If the foreskin, placed where it is, with its unique rolling action, does NOT have a sexual function, what was God/evolution thinking?
You are absolutely right that routine circumcision to prevent things like penile cancer is probably not warranted. Penile cancer is rare to begin with and the amount of risk reduction brought by circumcision is likely not worth the cost. However, in the case of STD prevention, the effects of circumcision are much larger and the effects are more immediately apparent. Thus, there is a very different cost-to-benefit analysis from a medical standpoint depending upon what outcome you look at.
I should also point out that while Weiss and colleagues authored many of the references I cited, I primarily cited reviews and meta-analyses. This means that they summarized the patterns across multiple studies conducted by a number of independent researchers. Thus, there is a much larger number of people advocating for the medical benefits of circumcision than just the authors of these reviews.
Again, please note that I am not pushing a certain position here—my goal is simply to make sure that the data and arguments are presented fairly on both sides. Neither perspective should be immediately dismissed. All too often, people make this decision without any thought and that’s what needs to be changed.
Providing unbiased info for consideration of the preventive amputation of normal genitals? It is a false "decision" made possible only by the medical community's granting of different and special rules for male children, rules which saying that for the infant penis all medical oaths, ethics and protocols may be discarded with parental permission. (A similar amputation for a girl, even a "ritual nick", is illegal, though there have been "studies" demonstrating that genitally-altered women are at lower risk for HIV (Stallings et al.) Those kinds of peer-reviewed studies do not incite a call for FURTHER prospective studies, stirring speculation at the "biologically-plausible mechanisms" (more folds, presence of Langerhans cells) by which "extra" skin may put women at risk, justifying preventive amputation.
Given this dichotomy in the application of ethics and medical intervention based on a child's sex, consider these observations of J.Steven Svoboda:
"We may uncover embedded in American beliefs about circumcision these "original myths" about males: 1) Males are inherently pathological, requiring correction at birth. 2) Male genitalia are not worthy of preservation. 3) Natural male genitalia are a health hazard. 4) Natural male genitalia are inherently unclean. 5) Males do not experience pain; they require no anesthesia. 6) It is better to cut away part of a boy's penis than to give a parent the task of cleaning it. 7) A male's body does not belong to him, but to some social group (religion or medicine) which acts "for his own good." 8) Restraining a male and cutting his genitals is good for him."
The medical establishment has been trying for years to create 'research' that justifies this specific surgery, rather than find ways to treat illness. Why when their 'research' has been disproven over and over do we keep listening to those promoting circumcision, when they clearly are more interested in promoting a a surgical procedure rather than look after the welfare of a healthy individual?
To quote you, "a clinical trial in Africa in which adult men were either circumcised or not (on a voluntarily basis, of course) had to be called off because the rate of contracting HIV was so much lower among circumcised men" ????
Um, you can't be serious! That is NOT why the trials were called off. The pro-cutters in charge realized the cut men with HIV were catching up with the intact men, and they couldn't chance that happening and invalidating their bogus results.
Most of these concerns you mentioned for an Intact/penis can be prevented simply by wearing a condom and cleaning your penis, why did you not mention that? "definitive evidence of reduced sexual satisfaction in adulthood" You must check your references on that one again. 20,000 nerve endings are found within the foreskin, perhaps referencing an article not from the states or pro-circ and using articles from the British Journal of Medicine would be of help. Its not giving fair treatment for both sides if you literally write a death sentence for one. How many parents and men and women are you going to scare and confuse? Even IF evidence points genital mutilation reducing risks, so does replacing my teeth with dentures lower the risk of getting cavaties, but I don't do that, I instead clean my teeth like most capable humans. I'm glad you mentioned Europe, because foreskins were such a problem then 85% of world's men population would be utterly suffering, which they are not. If anything the epidemic is shown in countries that mass circumcize such as the USA and Sub-Saharan africa. In fact 10 out of the 18 African countries show an increase HIV in Circumcision. Where is the prevention there? Condoms prevent HIV not circumcision, if you have sex with mutiple partners and without condom, you are bound to be burned. I recommend reading at least Boyle & Hill's article on the African HIV studies and you will see how clear the fallacy is between HIV and circumcision.
Boyle GJ, Hill G. Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: Methodological, ethical and legal concerns. J Law Med 2011
Regarding HPV and HIV:
http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA458066
A US Navy finds that circumcision does not prevent HIV or STIs. "Although there may be other medical or cultural reasons for male circumcision, it is not associated with HIV or STI prevention in this U. S. military population."
http://jid.oxfordjournals.org/content/203/1/58.abstract?sid=8b0e0470-d2bf-4989-b147-bfdd83c72abb
Another studys shows that HPV prevalence and associated factors among men on five different continents showed that "Neither condom usage nor circumcision was associated with HPV DNA prevalence."
http://www.cirp.org/library/disease/STD/cook2/
Another study shows that circumcized men were Circumcised men were more likely than uncircumcised men to have genital warts, but when present, warts were more often located on the distal portion of the penis among uncircumcised men. This paradox is not understood, but could reflect either non-specific resistance to proximal penile warts conferred by the foreskin, or heightened susceptibility to various HPV types in uncircumcised men, some of which may confer subsequent immunity to genital warts."
http://www.cirp.org/library/disease/STD/donovan1/
Yet another study showing that circumcision does not prevent or reduce STDS. A study done in a developed nation setting showed that "From the findings of this study, circumcision of men has no significant effect on the incidence of common STDs in this developed nation setting. However, these findings may not necessarily extend to other setting where hygiene is poorer and the spectrum of common STDs is different."
I just found that you provided a "victimizing" perspective for men who are intact, which is not true at all, seeing how there is no epidemic, espeically in countries with low circrates such as the countries part of Scandinavia.
I appreciate all of your comments. However, I do not find it plausible that the medical community has been faking research on circumcision in order to more widely promote the procedure. There is simply no evidence of fraud in the research on this topic. I realize that many people feel very strongly that circumcision should not be performed as a matter of routine medical practice, but in arguing against it, I do not think it is productive to simply dismiss the research you do not agree with and claim it has been faked without offering any substantive support for that contention.
As for the research cited that suggests no benefits of circumcision, yes, you can absolutely find some studies saying that—and I do not dispute that they exist. However, most of the papers I cited in my post were meta-analyses and review articles that statistically summarized the pattern across ALL of the research conducted on this topic. Thus, while some studies have found no effect, many others have found significant results—and the broader pattern in the literature is that there appears to be a hygienic benefit of circumcision. Thus, we need to have a conversation about the entire literature in this area, not just a couple of specific studies.
I should also mention that even if circumcision does have hygienic benefits in terms of reducing STD risk, it is certainly not guaranteed to prevent disease. Condoms and smart sexual decision-making are still essential for good sexual health. And there is indeed a danger that if we say “circumcision prevents disease” that circumcised people will assume they don’t need to take other precautions (i.e., they might think that because they’re circumcised, they can have unprotected sex without worrying about the consequences). Thus, it is important to ensure that any messages being sent about the potential benefits of circumcision make this clear. Circumcision is not in any way a substitute for safe sex, and I thank the commenter who raised this point.
Lastly, with respect to the issue of the effects of circumcision on sexual satisfaction, there is no clear evidence anywhere in the scientific literature that circumcised men are any less sexually satisfied or have more difficulties with sexual arousal or orgasm compared to uncircumcised men. The evidence just isn’t out there. You can argue this point all you want, but without data to back it up, there really isn’t a productive argument to be had on the topic of circumcision and sexual satisfaction.
Once again, I am not advocating for a certain position here—my goal is simply to ensure that the research and arguments on both sides are clearly and fairly presented. This post is not meant to scare anyone into or out of circumcision. All it is designed to do is get people talking about a subject that all too frequently gets ignored.
"the studies into HIV prevention were carried out in sub-Saharan Africa, where transmission mainly takes place through heterosexual contact. In the western world, HIV transmission is much more frequently the result of homosexual contact and the use of contaminated needles. That the relationship between circumcision and transmission of HIV is at the very least unclear is illustrated by the fact that the US combines a high prevalence of STDs and HIV infections with a high percentage of routine circumcisions. The Dutch situation is precisely the reverse: a low prevalence of HIV/AIDS combined with a relatively low number of circumcisions. As such, Non-therapeutic circumcision of male minors behavioural factors appear to play a far more important role than whether or not one has a foreskin."
Source: The non-therapeutic circumcision of male minors, KNMG, May 2010.