Cut It Out: Circumcision Revisited

Edan Tasca

 

Kramer: A bris? You mean circumcision. . . . I would advise against that.
Elaine: Kramer, it’s a tradition.
Kramer: Yeah, well, so was sacrificing virgins to appease the gods, but we don’t do that anymore.
Jerry: Well, maybe we should.

—“The Bris,” Seinfeld, season 5, episode 5

The February/March 2012 issue of Free Inquiry published “Snip the Snip,” my critique of routine male circumcision and its justifications (prophylactic,hygienic, cosmetic, and religious). The piece drew criticism to which I was able to reply in brief (see Letters, FI, April/May 2012, ). Among other concerns, it was suggested that I hadn’t given enough attention to the evidence touted as prophylactic benefit; and that my comparing the practice to female “circumcision” or to other unnecessary amputations of, say, a pinky toe or an earlobe, was unacceptable. These criticisms deserve a more thorough response.

My essay did address the often-cited studies conducted in South Africa, Kenya, and Uganda that showed a significantly lower rate of HIV infection in circumcised men than in their intact counterparts. The studies made news and even earned a mention in SuperFreakonomics, whose authors point out the relationship and that not even the researchers themselves or scientists fully understand it. Nevertheless, it was reported that the Centers for DiseaseControl and Prevention (CDC) was considering recommending routine male circumcision based on the findings.

In March 2012, the journal Cancer released a study showing a lower rate of prostate cancer in subjects who were circumcised before their first sexual experience, compared with their intact counterparts. In August 2012, the American Academy of Pediatrics (AAP) declared that circumcision’s benefits outweigh the risks. Here we go again.

The CDC didn’t recommend routine circumcision to prevent HIV. The American Cancer Society won’t recommend circumcision to prevent prostate or any other cancer, and the AAP still does not recommend routine circumcision. This is because the arguments against circumcision annihilate those in favor of it.

Assuming we make the mistake of crowning the HIV studies as some kind of final word, we still lack a direct causal relationship. Various interpretations have emerged, some theorizing about why the presence or lack of a foreskin would account for the results, some suggesting other factors are involved. In the case of HIV, it’s also worth noting that the United States has a higher rate of HIV infection than Europe and also a higher circumcision rate, which doesn’t fit with the studies’ findings.

Nevertheless, in 2007, WHO/UNAIDS released its New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications. It states that“Promoting male circumcision should be recognized as an additional, important strategy for the prevention of heterosexually acquired HIV infection in men.”Looking a little closer, however, we find the following: “Informed consent, confidentiality and absence of coercion should be assured. . . . Where male circumcision is provided for minors (young boys and adolescents), there should be involvement of the child in the decision-making, and the child should be given the opportunity to provide assent or consent, according to his evolving capacity. . . . Parents who are responsible for providing consent, including for the circumcision of male infants, should be given sufficient information regarding the benefits and risks of the procedure in order to determine what is in the best interests of the child.”

This stops well short of a triumphant “case closed.” Not only grown men but also young African boys continue to have a say in the potential removal of a key part of their penis. Even in the case of newborns, the most ardent supporters of prophylactic circumcision have been cautious, electing to put human rights, consent, and risk-versus-benefit above all else, even in the midst of an HIV epidemic. In the West, then, we certainly needn’t consider circumcision an HIV prophylactic, unless you assume your son is likely to seek unsafe sex in Africa. Surely it would suffice to trust in your ability to raise him and teach him how to protect his health.

In the case of prostate and other cancers, male and female, we can look to the American Cancer Society’s lack of a recommendation and to our treatment of breast-cancer risk. You’ll notice that we don’t routinely remove breasts, even though the risk of breast cancer is comparable to prostate cancer and far worse than for other cancers and HIV.

This is perfectly in line with our rule to not remove body parts unless a problem exists. The alternative—who could ever fracture a baby toe if it was removed at birth or develop skin cancer on a missing earlobe?—is unthinkable. Circumcising because of unwarranted concerns about ancillary issues—despite the lack of a recommendation from the world’s major medical organizations, mind you—is a use of evidence as bizarre as avoiding exercise because of the risk of injury, or taking up smoking to reduce one’s risk of Parkinson’s disease, or ramping up a society’s abortion rate in the hopes of mitigating future crime. When we’re thinking straight, we bet on the strong horse: exercise is good, smoking is bad, abortion is not a crime-fighter, and routinely severing body parts is completely unnecessary, whether for a daughter or a son.

For various reasons, the male version of circumcision seems more humane. We’ve all seen and heard the horrifying images and stories about many of thefemale versions. This contrast creates a situation similar to what psychologist Robert Cialdini called the “door-in-the-face” technique, whereby somethingundesirable is made to look less so when compared with something even worse. Let’s not have some good-cop/bad-cop fallacy dupe us. Our ideal of humane circumcision is itself a frank admission that we’re dealing with something otherwise inhumane.

And just how humane are we? There are mounds of tales from brises and hospital or medical-clinic waiting rooms that involve particularly nasty and unending screams and wails of newborns. There are other tales of babies seeming to pass out as a result of the cut. Some say this is the infant going into shock.All of this is anecdotal, of course, and therefore relatively inadmissible.

The empirical research doesn’t bother to investigate whether circumcision is painful; it investigates various methods of alleviating the trauma. This involves pain scores, based on respiratory and cry rates, facial “action,” gross motor behavior, palm sweat, systolic blood pressure, intracranial pressure, inhibition of the heartbeat—you get the idea.

I won’t dwell on the particulars. To sum up, in 2004 a systematic review from the National Institute of Child Health and Human Development examined the results of thirty-five studies on circumcision pain. It concluded that “None of the studied interventions completely eliminated the pain response to circumcision,” and that “Future studies should compare two or more active interventions for pain relief—a placebo or no-treatment control group is no longer acceptable.”

The temptation to contemplate the porosity of our ethics boards forces one to admit—and lament—the more general shortcomings of our critical thinking. It is literally a crying shame that the same review states that “Rece
nt surveys indicate that significant numbers of obstetricians (75%), family practitioners(44%), and pediatricians (29%) do not use analgesia/anaesthesia for circumcision because of concerns about adverse drug effects or because they believe that the procedure does not require pain management.”

No, he won’t remember it. Nor will he remember any other pain experienced at that age, which shouldn’t be much, because we know to protect him from it.

It’s obvious to readers of Free Inquiry that ancient religious scripture and the accompanying dogma are the work of primitive men and that humanity continues to suffer the consequences. It should be equally obvious that defenses of routine circumcision are ad hoc grasps at justifying a tradition that has sneaked past our common sense, lingering now as a descendant of the deplorable ancient rituals of the same primitive men.

If history had unfolded somewhat differently, we might today be debating dubious benefits of female circumcision, while the mere suggestion of removing aforeskin would be as repugnant as the non medical removal of any other body part and any justifications as absurd. Instead, we ignore the uncountable numbers of intact males across the globe who’ve never complained. Instead, there are doctors who will convince trusting, loving parents that removing their son’s foreskin is preferable to teaching him to clean his penis. Instead, it’s the eccentric character in the ubiquitous sitcom who’s trying to spare the baby boy, while we blithely laugh at the silliness.

Enough. There is an excruciatingly simple and convenient solution to all of this. Leave him be. Let him decide for himself.


Edan Tasca is a Toronto-based writer and editor.

Edan Tasca

Edan Tasca is a Toronto-based writer and editor.


  Kramer: A bris? You mean circumcision. . . . I would advise against that. Elaine: Kramer, it’s a tradition. Kramer: Yeah, well, so was sacrificing virgins to appease the gods, but we don’t do that anymore. Jerry: Well, maybe we should. —“The Bris,” Seinfeld, season 5, episode 5 The February/March 2012 issue of Free …

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