Circumcision

Circumcision (also called prepucectomy) is the surgical removal of a portion of the prepuce or foreskin of the penis of male human beings.

Male circumcision is an essential religious practice of Judaism; according to many Muslim religious leaders, it is an important element of Islam; it also has been and continues to be an important part of religious and cultural practices for many other ethnic and religious groups, including many African tribes. The Jewish ceremony of circumcision is called a Brit milah or Bris Milah (Hebrew).

Some people practice a form of circumcision known as subincision.

Circumcision is routinely performed in many countries for medical reasons. Neonatal male circumcision is the most common pediatric operation carried out in the U.S. and in Australia today, though only on a minority of newborn males. The United Kingdom also practices circumcision on a minority of males. The practice is almost unknown in the rest of Europe and all of Asia, except as a religious ritual.

Based on decades of medical studies, most medical doctors accept that routine male circumcision has a number of proven health benefits. However, the benefits are judged to be rather small. As such, in western nations current medical opinion (see below) is that, given proper hygiene, the small health benefits from circumcision do not outweigh the risks. As such, routine circumcisions are no longer recommended. Instead, most medical groups now reccomend providing parents with information on the topic, and allowing them to make their own choice.

There are a number of circumstances where most doctors do reccomend circumcision. An overtight foreskin can cause problems in sex, as the foreskin may become trapped behind the glans of the penis and restrict blood flow (paraphimosis). Amputation of the entire foreskin (circumcision) is a remedy for this condition, however it is also treatable by a simple program of stretching, or by minor surgery to make a small slit in the foreskin without removing any erogenous tissue.

Circumcision is indicated in cases of recurrent balanitis or paraphimosis. Circumcision is contra-indicated in the case of a hypospadias, as the foreskin can be used to repair this birth defect.

Medical analysis of circumcision

Many studies have shown that circumcised males had a reduced risk of penile cancer, or that their mates had a lower risk of cervical cancer; however some of these conclusions are no longer fully accepted. One of the reasons is that the incidence of penile cancer is very low: in the United States there are more annual fatalities from circumcision complications than from penile cancer; in males, breast cancer is approximately twice as common as penile cancer.

The American Academy of Pediatrics created a Task Force on Circumcision, which issued an official policy statement. The abstract of their statement reads:

"Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. If a decision for circumcision is made, procedural analgesia should be provided."

The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists issued a statement in 1997 that "newborn circumcision is an elective procedure to be performed at the request of the parents on baby boys who are physiologically and clinical stable."

The American Academy of Family Physicians Reference Manual states: "Current medical literature regarding neonatal circumcision is controversial and conflicting. The decision to perform neonatal circumcision should be based on the informed consent of the parents, and requires objective, factual counseling of parents by the family physician"

In recent years the American Cancer Society has come out against routine circumcision. "We would like to discourage the American Academy of Pediatrics from promoting routine circumcision as a preventive measure for penile or cervical cancer...Perpetuating the mistaken belief that circumcision prevents cancer is inappropriate." The American Academy of Pediatrics no longer promotes routine circumcision.

The American Medical Assocation states:

There is little doubt that the uncircumcised infant is at higher risk for urinary tract infection (UTI), although the magnitude of this risk is debatable.. Despite the increased relative risk in uncircumcised infants, the absolute incidence of UTI is small in this population... One model of decision analysis concluded that the incidence of UTI would have to be substantially higher in uncircumcised males to justify circumcision as a preventive measure against this condition.

The data on circumcision status and susceptibility to HIV infection and other sexually transmissible diseases have been recently reviewed. Five of 7 prospective studies involving heterosexual transmission of HIV-1 found a statistically significant association between lack of circumcision and elevated risk for acquisition of HIV... At least 16 studies have examined the relationship between circumcision and sexually transmissible diseases other than HIV. In general, circumcised individuals appear to have somewhat lower susceptibility to acquiring chancroid and syphilis, possibly genital herpes, and gonorrhea compared to individuals in whom the foreskin is intact... Regardless of these findings, behavioral factors are far more important risk factors for acquisition of HIV and other sexually transmissible diseases than circumcision status.

(Source: American Medical Assocation, Report 10 of the Council on Scientific Affairs on Neonatal Circumcision)

Medical complications of circumcision

Complications of circumcision are rare: they range from disfigurement, scarring and sexual dysfunction through severe mutilation of the penis, to (in the extreme case) death.

Penile hygiene is equally effective as circumcision: "Clearly it is good hygiene, not the presence or absence of the foreskin that matters." (J.S. Black, Patient Management, March 1992, p. 71); "the relationship of circumcision to cancer of the penis seems real, but even minimal hygienic standards are probably just as effective in prevention." (M L Sorrells, Still More Criticism, Paediatrics Vol 56, 1979, p. 339).

There are sexological studies suggesting that even successful circumcision makes the penis less sensitive to stimulation. This effect of the procedure is sometimes presented as an advantage (prolonging the sexual act) or as a disadvantage (decrease in sensation). However, these results are highly controversial.

Circumcision in history and society

The origin of circumcision is hidden in the midsts of pre-history; historians currently do not have information that would allow them to definatively say where and why this practice originated. It is possible that it arose as a religious ritual, as a form of sympathetic magic, as a health control measure, as a way to control the sexuality of children and adults, or as a way to to prevent masturbation. It is possible (some consider likely) that it may have independently developed in different cultures for different reasons.

Desmond Morris offers this possibility "The Egyptians believed that when the snake shed its skin, and emerged shiny and new again, it was undergoing rebirth. They reasoned that if, by shedding skin, the snake could become apparently immortal, then humans should follow suit. They made the simple equation: snakeskin = foreskin, and the operation began." Others, however, strongly question whether the snakeskin metaphor was the original motivation, and suggest that it may have been an after-the-fact justification.

Karen Ericksen Paige has written about medical fears associated with masturbation and the various attempts to control it, especially circumcision. She writes: "In the United States, the current medical rationale for circumcision developed after the operation was in wide practice. The original reason for the surgical removal of the foreskin, or prepuce, was to control 'masturbatory insanity' - the range of mental disorders that people believed were caused by the 'polluting' practice of 'self-abuse.'"

"Self-abuse" was a term commonly used to describe masturbation in the 19th century. Paige describes circumcision became popular as a masturbation remedy:

"In the 1890s, it became a popular technique to prevent, or cure, masturbatory insanity. In 1891 the president of the Royal College of Surgeons in Great Britain published On Circumcision as Preventive of Masturbation, and two years later another British doctor wrote Circumcision: Its Advantages and How to Perform It, which listed the reasons for removing the 'vestigial' prepuce. Evidently the foreskin could cause 'nocturnal incontinence,' hysteria, epilepsy, and irritation that might 'give rise to erotic stimulation and, consequently, masturbation.' Another physician, P.C. Remondino, added that 'circumcision is like a substantial and well-secured life annuity...it insures better health, greater capacity for labor, longer life, less nervousness, sickness, loss of time, and less doctor bills.' No wonder it became a popular remedy."

(Source: Karen Ericksen Paige: "The Ritual of Circumcision". Human Nature, pp. 40-48, May 1978 (online version with illustrations).

Harvey Kellogg, who is well known for his psuedo-scientific views on human sexuality, has written on this issue. He advocated the consumption of Kellogg's corn flakes to prevent masturbation, and he believed that circumcision would be an effective way to eliminate masturbation in males.

"Covering the organs with a cage has been practiced with entire success. A remedy which is almost always successful in small boys is circumcision, especially when there is any degree of phimosis. The operation should be performed by a surgeon without administering an anæsthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment, as it may well be in some cases. The soreness which continues for several weeks interrupts the practice, and if it had not previously become too firmly fixed, it may be forgotten and not resumed. If any attempt is made to watch the child, he should be so carefully surrounded by vigilance that he cannot possibly transgress without detection. If he is only partially watched, he soon learns to elude observation, and thus the effect is only to make him cunning in his vice."

See masturbation for a brief discussion of the physiological effects of circumcision on masturbation.

Despite the euphemism under which it is sometimes called, "female circumcision", female genital mutilation is often (but not always) a much more invasive and damaging procedure than male circumcision as practiced today, often including infibulation.

The anti-circumcision movement

A modest number of anti-circumcision groups have developed in recent years; they term all forms of circumcision to be "sexual mutilation of infants", and consider circumcision to be "barbaric". Some hold that circumcision is especially problematic when performed without anaesthesia on the infant, as is common, but most in these groups oppose circumcision even with anaesthesia.

The goal of most of these groups is to end, and eventually criminalize, circumcision. Jewish and Muslim groups strenuously oppose such an agenda, as it would criminalize a key practice of their religion.

Some of the anti-circumcision groups include: BUFF (Brothers United for Future Foreskins), UNCIRC (UNCircumcising Information and Resources Center), NOHARMM (the National Organization to Halt the Abuse and Routine Mutilation of Males), and NORM (the National Organization of Restoring Men) and its predecessor, RECAP (Recover a Penis).

Some suspect that anti-semitism may be an influence behind some of the efforts to get rid of male circumcision, partly because of a distinct Anti-Semitic element among many opponents of circumcision, and partly because many of the people who speak out against circumcision attack Judaism specifically, yet make little or no attempt to speak out against other faiths or cultures that have the same practice.

One of the positions held by opponents of circumcision is that a small part of the infant's body is being unnecessarily and permanently removed without the subject's consent.

There exists a small but growing and vocal group of men who regret having been circumcised. Some are activists who try to inform people that the procedure is no longer necessary, while others seek to regain their foreskin through medical procedures. More of them attempt non-medical methods such as stretching the skin covering the distal penile shaft down over the glans penis through techniques such as wearing weights on it, or taping the skin over a small cap worn over the glans. This process is known as foreskin restoration. They report to have some success, although a great deal of patience and consistency is required to have any permanent affect. Cosmetic surgical procedures to repair the foreskin also exist; but none of these methods can repair the erotogenic nerves that are severed during circumcision. Some have tried to challenge the legal status of circumcision.

A small number of circumcised males claim that latent results of circumcision through life include irritation of the glans penis and a loss of sexual sensitivity. This claim is disputed; many adult males who have undergone circumcision report that their sex life is unchanged after the procedure; also, exposing the more sensitive penile skin under the foreskin may well cause an increase in the amount of sensitivity. The number of people who claim reduced loss of sensation is not statistically valid, as it they are self-reproting and this present the most egregious kind of selection bias.

External links

• Circumcision FAQ by Geoffrey T. Falk
• The Case for Labectomy by Jason Rohrer, a satirical anti-circumcision text.

References

John Harvey Kellogg Treatment for Self-Abuse and its Effects in Plain Fact for Old and Young. Burlington, Iowa: F. Segner & Co. (1888). P. 295