Snip the Snip

Edan Tasca

Picture the moment of gorgeous relief when labor is finally over and your doctor hands you your healthy baby boy. He has everything in the right place: ten, ten, two, and one. Then imagine that the doctor asks if you’d like to have one of your son’s pinky fingers removed.

Confused, you ask why anyone would consider such a thing. He explains that many parents find that it’s much more convenient to remove the pinky when the child is very young, so that the boy won’t remember the trauma and pain of the procedure. You ask for clarification: “Why would parents do it at all?”

The doctor informs you that some people do it for religious reasons and some out of a sense of tradition. Others do it for hygienic reasons (kids can accumulate a lot of gunk under that tiny nail!). Some doctors recommend that the finger be removed so that its skin cells can’t become cancerous and its bone can’t suffer a fracture. You stare and wait to be enlightened by a sound reason to remove this delicate part of your boy’s anatomy. But the doctor has run out of reasons. He can see you’re not interested so he leaves you alone.

It’s obvious that removing a baby’s pinky finger is unconscionable. It would constitute some kind of assault and would result in the doctor’s incarceration. I trust you’ve figured out that I’m not really talking about the removal of one of the smallest of fingers. I’m talking about the removal of a much more delicate and unique part of the body: the prepuce, or foreskin, which is often cut from a boy’s penis for reasons very much like those offered above. I’m talking, of course, about routine infant male circumcision.

When confronted with the prospect of committing an irrevocable procedure like the removal of an infant’s body part, we have to ask ourselves whether there exists a worthwhile benefit. Is there a reason good enough to outweigh the costs, which include pain and trauma for the infant, a chance of complications, or the alteration of the way the penis functions by removing a useful part of it? If we can find no such reason, the practice should be dropped altogether.

In San Francisco, routine male circumcision was recently challenged. A petition garnered more than enough signatures to put a ban of the practice to a vote in November 2011. Unfortunately, the referendum was blocked by court action. The arguments against the ban and in favor of circumcision tend to fall into one of four categories: pseudo-medical, hygienic, cosmetic, and religious. Examining these justifications shows them, and their sum, to be inadequate.

Pseudo-Medical

Reports on circumcision rates in the United States vary, but the rates seem to be dropping in recent decades, perhaps as a reaction to important questions about whether there are any good reasons—or even just one—for the practice. In 1971, the American Academy of Pediatrics deemed that there is “no absolute medical indication for routine circumcision” and that it is “not essential to the child’s current well-being.” Similarly, neither the American Medical Association nor the American College of Obstetricians and Gynecologists recommends the practice. In fact, the list of the world’s major medical organizations that officially do not recommend routine circumcision is so long that reproducing it here would be impractical.

However, despite the stance of the experts that there is no health-related reason to circumcise, you might have heard one or two pseudo-medical arguments in favor of the practice.

HIV. In what would be circumcision’s biggest boost of support in ages, the Centers for Disease Control and Prevention (CDC) is considering recommending the surgery as a routine procedure to reduce the spread of HIV. It would base this recommendation on three studies—run in Uganda, Kenya, and South Africa—that have shown a lower incidence of HIV in circumcised men when compared with intact men.

First, there have also been studies, including at least one in Kenya, that suggest there is no difference in HIV rates between circumcised and intact males. Further, circumcision rates in Europe are lower than they are in North America, and yet the rate of HIV in Europe is also lower.

Second, even if the African studies are correct in identifying a pattern, they pertain to Africa, not to the West. HIV environments in Africa and the West are not similar. HIV in Africa is an epidemic, spread mostly by unprotected heterosexual sex. In the West, HIV infection is extremely rareand spread mostly by needle-sharing and homosexual anal sex.

Third, why would we treat infant males as if they’re adults? Babies are not sexually active and don’t need to be protected from HIV.

UTIs and cancer. Even less convincingly, some have argued that circumcision is justifiable as a preventive measure against urinary tract infections (UTIs) and even against penile cancer. UTIs are rare, they tend not to be serious, and when they do occur simple antibiotics are an effective treatment. Statistically, to prevent one UTI, we have to circumcise approximately one hundred boys. That’s drastic, considering circumcisions themselves can cause complications such as excessive bleeding and infections (and, in very rare cases, much worse).

Cancer, of course, is much more serious, but the American Cancer Society states that “most researchers now believe [studies suggesting lower penile cancer rates among circumcised men] were flawed because they failed to consider other risk factors, such as smoking, personal hygiene, and the number of sexual partners.”

Even if these studies were impregnable, however, it would be absurd to routinely, preemptively remove a foreskin to prevent a cancer whose incidence, according to the American Cancer Society, is 1 in 100,000 when we don’t routinely, preemptively remove breasts to prevent a cancer whose incidence is a very serious 1 in 8.

Better safe than sorry? You might be unable to erase that lingering doubt. What if you don’t have your baby circumcised and he contracts HIV? Perspective is everything. Humanity doesn’t take orders from the very unlikely. Auto accidents and plane crashes kill a tiny number of people; we still drive and fly. Cranes have collapsed and scaffolds fallen; we still build. Women die—very regularly—from breast cancer. We would never routinely preemptively remove breasts.

Further, such micro-considerations exist on the other side of the issue as well. For example, there are men pressing lawsuits against the parents and doctors who circumcised them without their consent. As another example, sometimes circumcisions go wrong—sometimes horribly wrong, sometimes causing permanent damage, sometimes requiring full penile amputation. The chance of some kind of complication from circumcision (say, the relatively benign problem of excessive bleeding) is actually higher than the risk of contracting penile cancer or HIV.*

Finally, these pseudo-medical justifications are not the reasons male circumcision came into being centuries ago, and they aren’t the reason it is a common practice today. These are ad hoc rationalizations to justify a practice that exists for nonmedical reasons.

Hygienic

By the nineteenth century, the medical establishment had adopted the position that circumcision was a hygienic procedure, which seems to be one of today’s leading justifications for the procedure. The foreskin has glands that produce a substance called smegma. If allowed to accumulate, the substance, not unlike sweat in armpits and wax in ears, can create an unpleasant odor and result in discomfort.

This might seem a good reason for circumcision until we remember that these potential problems are easily avoided with the kind of cleaning we all do every day. A pinky finger will also require some cleaning under the nail to keep gunk from accumulating. Surely mere convenience doesn’t warrant the removal of a useful part of the male body. And a girl’s genitals present many of these same problems (they can develop cancer and infections; they produce smegma). But not only do we not circumcise baby girls, we recoil at the thought.

Cosmetic

Some parents worry that an intact foreskin might create cosmetic stress for the child—that perhaps he’ll feel strange not looking like the other boys in the locker room or not looking like his father. Social conformity is rarely if ever a sufficient justification (imagine an argument that gay couples shouldn’t be allowed to raise a family lest the children get teased). In any case, as circumcision falls out of favor, an intact penis won’t be rare.

As for a boy not looking like his father, there are many other ways in which his appearance will differ. For varying significant amounts of time he’ll be much shorter, likely thinner, and without facial hair. There might also be static differences, such as eye and hair color and maybe handedness. And what of adopted boys from, say, Africa or Asia? They might look drastically different from their fathers. None of these superficial differences is something we worry will significantly perturb a child.

Religious

We owe the advent of circumcision to religion. There is debate about its exact origins, but the practice dates as far back as ancient Egypt, where it seems to have been a less severe form of ritual blood sacrifice. Instead of killing a valuable member of your livestock or even a fellow human, it would do to offer the gods part of an infant’s genitals. Later, the monotheistic religions adopted the practice in varying ways, often as a rite of passage, in which form it remains with us today.

First, there’s obviously no longer a call for blood sacrifice. (Alas, if there never had been, we would never have heard of routine circumcision, and we wouldn’t even be having this debate.) Second, the monotheistic religions’ argument is self-contradictory. We have to assume that if our designer weren’t a fan of male foreskins, he would be intelligent enough to cease providing us with them. Simply put, if we’re created in God’s image, there should be no reason to make this adjustment.

Third, circumcision was for a time recommended as a way to discourage the perceived sin of masturbation (as it still is for girls in some parts of the world). The missing foreskin was thought to significantly lower sexual sensitivity, a possibility we certainly want to avoid. Finally, there’s the essential matter of keeping religion and government separate. As we do with baby girls, society should protect every part of the infant male body with no religious exceptions.

So the prognosis for the health-benefit argument isn’t good; we’ve washed away the hygiene argument; the cosmetic argument is shallow; and the argument from religion is self-defeating. Maybe you’re thinking, “Alright, there’s no Holy Grail reason. But all those considerations, when combined, certainly amount to one general, overriding reason, no?”

No. When we add zero to zero, we’re left with zero. When we multiply zero a billion times, we’re still left with zero.

The Useful Prepuce

“But it’s just a piece of skin,” you might say. “What’s the big deal? It’s not like a breast, which provides nourishment for babies, or a pinky finger, which helps us grip objects.”

Even if it were nothing more than a useless flap of skin, we shouldn’t remove it, for the same reason we shouldn’t remove our boy’s earlobe. The penis has evolved in such a way as to develop this useful body part. The prepuce covers the tip of the penis, preventing the drying and calcifying, and, perhaps, lowered sensitivity experienced by circumcised men. During intercourse, the prepuce serves as a tubelike wrap, providing a built-in lubricantlike coating that allows for what’s known as sexual gliding, which, it has been argued, helps to lessen the effects of vaginal dryness and which might be responsible for a particular kind of sensation for the male. Debate continues about whether intercourse is actually more enjoyable for intact men than their circumcised counterparts, but it does stand to reason that there exists some kind of tactile advantage from that protective hood and those millions of extra nerve endings.

The prepuce, then, is not akin to an appendix, an extra finger or toe, an earlobe, or a tail. And even if it were, (1) we do continue to find out more about the appendix, spleen, and gall bladder, and (2) we don’t remove the appendix, for example, until a pressing need arises. Once the original foreskin is gone, it’s gone forever. Foreskin restoration, whether surgical or otherwise, can be expensive and risky and cannot re-create the natural foreskin that was removed.

If you’re not convinced that there’s no valid reason to circumcise your son, you probably don’t see a comparison to pinky-finger removal. The problem here is again simply one of perspective: one about what we are and aren’t used to. Circumcision has been with us, relatively unquestioned, for so long that we’re accustomed to it. The removal of a pinky finger, however, is new and strange and offensive. How likely is it that the CDC, for example, would consider recommending the routine surgical removal of part of a baby’s penis for dubious reasons if we weren’t already accustomed to the practice? I would guess that it’s less likely than an unthinkable recommendation of routine mastectomies.

Most telling is our disgust toward female circumcision. This is an honest reaction that reveals our tolerance of male circumcision to be dishonest. What we’re used to has obscured our perspective and clouded our judgment. Considering the similarities between the relatively unquestioned practice of circumcision and its pinky-finger counterpart (including pain and whatever other trauma is inflicted on the infant), it is alarming that we don’t ask important questions often and loudly enough, and, worse, that our doctors, whom we rely on for advice in these matters, aren’t stressing often enough that there are not worthy reasons for the infant penis to be the only body part exempt from protection under the law.

Occam’s Razor

To close, I offer two quick and final points. First, you’ve likely heard of the philosophical principle known as Occam’s razor, which is the idea that the simplest theory or paradigm is best. In other words, don’t complicate things unless there’s a good reason. Occam’s razor, ironically enough, tells us to drop the razorlike tool and cease cutting off the foreskin—to leave our baby boy the way he was when he came out of the womb.

Second, we are fortunate to be able to play it safe, meet in the middle, and have it to some degree both ways. If you keep it simple and leave your boy intact, he will grow into a mature adult, able to freely weigh the pros and cons, and then choose for himself whether he wants to have his foreskin removed.

I can anticipate the counterargument here: this is not playing it safe, not meeting in the middle, and not having it both ways, because it’s extremely unlikely—unthinkable, even—that a young man would see a good reason to have part of his penis cut off.

Exactly. And what does that tell us?

 


* According to a summary of the research from Canadian Paediatric Society, the rate of some kind of complication from circumcision can vary widely. The authors state that “the rates of complications reported in several large case series are low, from 0.2 percent to 0.6 percent. However, published rates range as widely as 0.06 percent to 55 percent. Williams and Kapila have suggested that a realistic rate is between 2 percent and 10 percent.” This is in contrast to the prevalence of HIV infection in the general population of adults aged fifteen to forty-nine, which is 0.5 percent in North America and 0.2 percent in Western Europe, much lower than the 2 percent and 10 percent for circumcision complications suggested above. Further, those HIV rates don’t take into account the difference between (1) the heterosexual population (lower rates), (2) homo- and bisexual populations, in particular gay men (higher rates), and (3) needle-sharing populations (higher rates). The CDC suggests that homosexual men, needle-sharers, and those accidentally injured by a stray needle account for a huge percentage of infections. That tells us that the HIV rate is even lower than 0.5 percent/0.2 percent for the adult population the infant is most likely to join (heterosexual and nondrug-sharing). There is no realistic comparison to be made between either circumcision complications or HIV rates and penile cancer, whose incidence, according to the American Cancer Society, is 1 in 100,000 (0.001 percent), accounting for less than 1 percent of cancer cases.

References

Edan Tasca

Edan Tasca is a Toronto-based writer and editor.


Picture the moment of gorgeous relief when labor is finally over and your doctor hands you your healthy baby boy. He has everything in the right place: ten, ten, two, and one. Then imagine that the doctor asks if you’d like to have one of your son’s pinky fingers removed. Confused, you ask why anyone …

This article is available to subscribers only.
Subscribe now or log in to read this article.