Some thoughts on Male Circumcision
One of the interesting things about running a semi-popular blog is that from time to time the blog community decides to take up a topic and run with it, completely without any stimulation from me. This happened recently on the Academic OB/GYN Facebook page, where a group of concerned individuals carried on a serious and passionate discussion about the merits of circumcision. As such discussions tend to be, this one was dominated by the anti-circumcision activists, with occasional interjections by those that were less concerned about the issue, including myself.
Circumcision is an interesting issue because it crosses multiple boundaries. It is a social tradition in many cultures, and in some cases considered a religious mandate. It is also an ethical issue for many, with some feeling that it is an assault on an infant with long term negative impact on their psychosocial health. For some it is just cosmetic.
As a young person, I always thought that my penis looked like penises were supposed to look. It looked like my father’s and my brother’s, and anyone else’s I had ever seen. For the most part, I was blissfully unaware that a penis could look any other way, until one day in high school when my world completely changed. I happened to see a friend’s penis we were showering after wrestling practice, and in that flash of a moment all kinds of things went through my mind. Did he have some kind of growth on his penis? Could he pee out of that thing? A few other choice thoughts. I can still remember the shock to this day. All I had ever seen looked like mine, and in that moment what I saw was foreign, revolting even. You see, from my frame of reference he looked like an alien. It took me a few minutes and SNAP! it came to me like a ton of bricks – he has a foreskin. He probably doesn’t have an alien death ray then. I can relax about that one.
Of course now I realize that I also was born with a foreskin, and at some point in early life had it cut off. Despite what was no doubt a anesthesia free surgical procedure, I have no memory of ever having had a foreskin, or of any trauma of it having been removed. It never occurred to me to miss my foreskin, but apparently others do.
I hear stories from various anti-circumcision activists about how men are traumatized by their lack of foreskin, or even that some use strange devices to try to restore their foreskin in some way. I am struck with these stories, and have one burning question – when did they start missing their foreskin? From the moment they had the capability to store long term memories, they had no foreskin. Being circumcised was their frame of reference; it was their ‘normal’. The only way they could ever ‘miss’ their foreskin would be through some outside influence that convinced them of some new ‘normal’, and that they were somehow incomplete. Some of these men express anger at their parents or doctors for circumcising them as an infant, it seems to me that this anger is misplaced. It would make far more sense for them to be angry at the person who felt the need to drive a message into one’s head they were somehow incomplete, a message without which the feeling of loss never could have occurred.
I also hear stories of how the lack of a foreskin somehow interferes with sexual pleasure. I just don’t understand how this can be verified. I can say that from a personal point of view, everything down there seems to work just fine. I also don’t notice a preponderance of Jews who do not enjoy sex. Anecdote aside, one can only know what one has, and so again, anyone that feels that their sexual pleasure was supposed to be better than what it was got that idea from some other person, not from their personal experience. There’s plenty of people with foreskins that feel like their sexual pleasure was supposed to be better as well.
My biggest question in all of this is just why? Why do people care so much about this? Its really hard to say that an infant is being victimized by the procedure. Their frame of reference is being changed, no doubt, but as that frame is changed so early in their life there will be no sense of loss unless someone feels the need to convince them of it.
One could just as easily ask ‘why circumcise?”. There are plenty of data to suggest that circumcision decreases horizontal transmission of some STDs and the rate of penile cancer, though these effects are small. The anti-circumcision folks like to act like this data doesn’t exist, but this is just their ignorance. When I first thought of writing this blog post I was going to lay all this data out, but as I now write I realize that it doesn’t really matter. Those that believe or don’t care will see the strength in the data, those that are against will call it faulty or corrupt in some way. So goes academia. In the end, circumcision is a cultural practice that is done for cultural reasons, not for medical benefit. In Jewish tradition, circumcision is done as a way of honoring the covenant between God and Abraham, a covenant which commanded that all of Abraham’s sons and male servants, and their descendants, as a mark of allegiance and agreement. Though I have Jewish heritage, I am atheist. Nonetheless, I would feel a cultural desire to circumcise my son when and if I have one.
Some of my comenters, of which there no doubt will be many, will call this stance unethical. To this I say “grow up”. We are hard pressed to find ethical principles on which all humans agree, and this is certainly not one of them. A very large part of this world feels completely fine with male circumcision, and if one doesn’t, they certainly are under no pressure to circumcise their son. This is one of the many things that we don’t all agree on.
Other commenters will say “I’m not against circumcision, I’m against forcing it on newborns.” This is the same as saying that we shouldn’t do ritual circumcision at all. That’s a perfectly fine goal if one is really against the procedure, but just state it that way. Male circumcision is a cultural rite performed on newborns. Its pretty obvious that by 18 years old, very few boys are going to choose to have their foreskins removed. Their frame of reference has already been set, and they are fine with who they are. If we did that, we would be just fine, just as we are with a large part of the population circumcised. A cultural tradition would be lost, but that would also be ok. It just wouldn’t really matter.
Other commenters will say “they are dangerous and cause complications.” This is a half-truth. By in large, they are not very dangerous. That said, like any surgical procedure, there are some small risks. There have even been babies that have died from complications of the procedure. Ultimately, it is very important that anyone doing circumcisions know what they are doing and doesn’t do them wrong.
In truth, its an issue that I don’t care a great deal about, and as such am vexed on why it matters so much to others. Sometimes when someone writes a piece on the net, they are instantly labeled as an activist for that cause. People certainly label me as an activist for delayed cord clamping, which I would deny. I just wrote an article about the topic and lots of people read it. They can make up their own mind. I just wish people would treat this issue the same way. Everyone is free to circumcise their child or not, and the boy will grow up just fine either way.
I fully expect an absolute flame war will ensue. As I am busy in a fellowship, my activity in such a discourse may be limited.
Academic OB/GYN 
Do you feel the same about female circumcision? Why or why not?
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I do feel that it is different, for many reasons. Female circumcision is not done at birth, and creates significant genital disfunction, interfering with both sex and elimination. It is a painful process that women remember their whole lives, and likely have PTSD from.
I can certainly see the parallel, and direct analogy as well, but it does seem a bit different to me.
I have had a number of patients who had female circumcision, and none of them look at it as having been a good thing. I have countless male friends who were circumcised, and none of them look at it as having been a bad thing.
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That’s not entirely true about female circumcision. Many women love being circumcised and feel that it’s a benefit to their sex life. For example, here is a highly educated woman Fuambai Ahmadu, PhD who claims that her FGM gives her a greater sexual pleasure than uncircumcised women. She has had her entire clitoris, hood, and inner labias surgically removed and states:
“I have satisfying sex; much, much more than my uncircumcised sisters who always have to think long and hard about the last time they had an orgasm, while I smile with glee because mine was only this morning! I am also a proud mother of two who suffered nothing at all at the conception or delivery of my children (both circumcised). We ARE the majority! As a professional career woman who has worked all over the world, I am very comfortable with who I am. No false hair, no weave on, no false eyelashes or false nails, no bleached skin, no phony accent… no desire to be white/cocasian. Just a curvacious, voluptuous, intelligent, beautifully complex, proud yet circumcised African lady.” – http://www.thepatrioticvanguard.com/article.php3?id_article=3752.
Also, many people do circumcised their daughters in infancy:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497147/
“A 36-year-old Ethiopian woman explained, “I had the foreskin on my clitoris removed as a baby, just like my brother . . . Why does everyone say it is so terrible and that I should have problems from it?” Circumcised female genitalia are considered normal to some Africans, just as circumcised male genitalia are normal to many Americans.”
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Jus because some women enjoy it does not mean it should become routine.
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Female genital cutting in Indonesia is done at birth by medical doctors because parents believe it is an important cultural and religious tradition for their daughter to be circumcised. The type of female genital cutting done in Indonesia only make a small incision in the girl’s genitals. It is less damaging than male circumcision.
In my opinion there is no ethical difference between Indonesian doctors who cut the genitals of healthy girls and American doctor who cut the genitals of healthy boys.
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So, if it were done at birth, removed only as much skin as male circumcision, left the clitoris alone, and did not involve sewing the vagina/labia shut, you would be okay with it?
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For better or for worse, female circumcision is also a quote/unquote “cultural” and “religious rite.”
We can talk about how much “different” it is, and how much more “medical benefits” it has. Actually, female circumcision *does* have medical benefits, but for whatever reason, “studies” and “research” in that field is ignored. Hrm. I wonder why. Could it be the West’s cultural bias against female circumcision?
Yes, let’s start talking about the “medical benefits.”
But realize that when this begins to happen, we abandon those precious tenets of “freedom of religion” and “parental choice.”
Please educate yourself. Did you know that in some countries, female circumcision is performed on baby girls? In Malaysia, Indonesia, Singapore, Brunei, Sudan and other countries in Africa, baby girls are circumcised in a religious ceremony known as “sunat.” You can find forums where parents talk about their daughters, and even their own “sunat,” the way we non-challantly talk about male circumcision on Western forums, by googling “Have you sunat your girls?”
Did you know that the United States and Israel are the only countries in the world that circumcise boys as babies?
It’s true. The men in the rest of the world were circumcised at an age where they can remember. Boys are circumcised in the Muslim world at ages 7 through 13. There are plenty of videos.
What do you think of that? Do you think the boys might get PTSD then? Or only girls?
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Well, it is interesting that you state that most of the world circumcises so that is considered “normal”. That is not true. 80%of men in the world are intact (not circumcised) and normal, like most women in the world. A foreskin has a purpose, why else would it be there? The female clitoral hood is there for a reason too. With both healthy, functioning sexual parts, intercourse is a normal action, aided by the gliding of the foreskin. The penis is meant to be a moving organ, not a dowel-like object. Infant circumcision is a human rights violation, because everyone has the right to normal, functioning genitals and removing the foreskin from a non-consenting minor violates that person’s rights to his whole body. It is interesting that men who are circumcised have no problems inflicting their fate upon others, how do you know what you are missing unless you understand the purpose and function of the foreskin. Since only 1% of men choose circumcision for themselves as adults, we should leave that choice to children. Education is key here, learn about what you are missing before you advocate removing it from others. His body, His decision.
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Parents make all kinds of decisions for their children that shape who they will be, least not of which is the teaching of religion. The instillation of a belief in god is an almost irrevocable and life changing alteration to a person’s frame of reference, and can really only be done at a time when a child still believes in fantasy. Leave someone unexposed to religion up through the onset of rational thinking, they will be unlikely to ever find it compelling. Kids don’t get to make that choice either, yet it makes a profound impact on their life, for better or worse, and far more so than whether or not they have a foreskin.
And if you read my post more carefully, I neither advocate for or against circumcision. I just find it odd that people give a damn about what others do in this regard.
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With the exception of piercing ears and male circumcision, parents are not allowed to make permanent body modifications to their child’s body. If you were to pierce a boy’s penis because his parent’s requested it for cultural or religious reasons, you would go to jail. Male circumcision is a more severe form of permanent body modification than genital piercing.
You oppose my right as a person to decide what permanent body modifications are done to my own body. There was no compelling reason for a medical doctor to cut off a normal, healthy part of my penis without my consent.
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Nicholas, you are playing ring around the rosy.
There is a difference in teaching religion, and permanently altering a child’s body.
Let’s come back to female circumcision. For better or for worse, it is also a “religious practice.” Yet, you yourself feel differently.
Either parents have complete authority to do whatever they want to their children, or they do not.
Is there a line to draw? Where is it?
Why stop at male circumcision? Why not include female circumcision?
If we start talking about “research” and “medical benefits,” have we not abandoned the arguments of “religious freedom” and “parental right?”
Let’s face the facts: If parents could do absolutely whatever they wanted with their children, there’d be no need for child protective services.
And please don’t pretend to be “neutral” on the matter. If you honestly didn’t care, you wouldn’t have bothered to make an entire rant post about the matter.
We live in human society. People give a damn. The drive to stop non-medical surgery in healthy, non-consenting children comes from a feeling that we should help those less powerful than ourselves.
It is the same reason people oppose FGM and go all the way to countries where it is perform to educate people.
Maybe that female circumcision is “mutilation” is our own culturally bigoted opinion? Maybe we need to re-think this and ask groups against FGM to stop trying to make parents feel guilty for doing this?
Some argue “I do this (male circumcision) out of love for my child.” Are parents who choose to practice their “religion” on their girls somehow less loving than those who practice it on boys?
For better or for worse, parents do this to their daughters because they believe they are doing her a favor. No parent thinks “I want to mutilate my child.” Parents in said countries get absolutely insulted and infuriated at the notion that they might be “mutilating” their daughters.
The time has come to analyze our own cultural practices.
Isn’t your job, and the job of other physicians to practice MEDICINE, and not religion or culture?
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>> And please don’t pretend to be “neutral” on the matter. If you honestly didn’t care, you wouldn’t have bothered to make an entire rant post about the matter.
Hardly a rant.
In truth I really don’t care. I found it fascinating that a group of people chose to make a 170 comment thread on my page completely spontaneously. I decided to post my own thoughts.
I understand that good people feel differently about this issue, just like good people feel differently about abortion.
I don’t recommend circumcision to my patients, nor do I discourage it. I respect it as a cultural choice.
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If you did not really care, you would not have posted as you did.
Not all cultural choices are created equal. There most definitely are cultural practices that must be discouraged, even resisted. And the vast majority of infant circumcisions in the USA are not motivated by culture, but by misconceptions about sex and hygiene, and by a fear that having nonconforming genitalia can be a grave social handicap.
If you are an atheist, there cannot a Chosen People, because there is no God to do the Choosing. If there is no Chosen People, there can be no Covenant between God and a Chosen People. If there is no Covenant, there is then no religious reason to circumcise.
American obgyns, who do most of the cutting, and American pediatric urologists, who deal with the serious sequaliae of RIC, are curiously incurious about the possibility that the male bits removed or damaged by RIC, namely the foreskin, ridged band, frenulum and frenular delta, can enhance sexual pleasure and function for both genders. This is apparently too much to ask of doctors who are either circumcised men or married to such. Worst of all, American medicine has yet to question a large random sample of women who’ve been in long term intimate relationships with both kinds of men. in recent years, a number of such women have spoken out in social media. My wife has not, but she definitely has a lot to contribute to this discussion.
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My husband wishes that he was not circumcised because he has negative consequences of the surgery — like many men. While he is not necessarily angry at anyone — he knows his parents didn’t know what they were doing — I find the idea that it’s misplaced to blame those who are responsible and instead blame those that are simply sharing factual information about the physiology of the penis. Once a man knows what he is truly missing, it’s hard for him not to regret that. I find that many adult men — especially those that are circumcised, have almost no idea how a foreskin works. Circumcision does change the function of the penis and it causes physical trauma to the area. Thankfully, the human body is resilient but overcoming circumcision does require compensation. And not every man can compensate in the same way. Not every man is resilient as the next in response to the physical changes to his penis. Many have hairy shaft, painful erections and/or loss of the sensory experience — leaving them with what feels more like an “on/off switch”. Those things point directly to circumcision.
And while I am a woman, I can tell you that I believe I would feel a sense of loss if I never got to experience my whole intact genitals — even if I were ultimately “fine”. When I hear circumcised men dispute that this should be the case for others, it makes me think that they are dealing with some deep seeded denial as a result of what was done to them.
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And how does a man “know what he is truly missing?” He can never know what he would have been with a foreskin, just as a person with one can never know what it was like to not have one.
>> Many have hairy shaft, painful erections and/or loss of the sensory experience — leaving them with what feels more like an “on/off switch”. Those things point directly to circumcision.
But only in your world view. There’s really no science behind what you are saying, and I hope you realize that.
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A man knows what he is truly missing when he becomes educated on the anatomy and function of the foreskin. The fact that he can’t experience what he is missing, doesn’t mean he can’t know what that is. He can know what meissner’s corpuscles are and that he is missing tens of thousands of them. He can learn about the gliding mechanism and know that he is missing that.
There’s no “science” behind the idea that a man’s flesh and hair will be pulled onto the shaft if too much of his foreskin has been removed? Really? I mean, that’s common sense. There is science behind what I’m saying. Do you mean, no “study” up to your standards that looks at these things specifically? Anatomy is a science.
Also, while I’m on the topic if studies — you stated that circumcision reduces some horizontal transmission of STDs and that the anti crowd denies this exists. It doesn’t exist! Not in the case of infant circumcision, which is what we are talking about.
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“And how does a man “know what he is truly missing?” He can never know what he would have been with a foreskin, just as a person with one can never know what it was like to not have one.”
The same can be said of girls who were circumcised as infants.
Does robbing a man blind “because he will never know what he is missing” make the act of robbery better, or worse?
“There’s really no science behind what you are saying, and I hope you realize that.”
There is no science behind the claim that female circumcision “destroys a woman’s ability to have an orgasm.” I hope you realize that too.
Actually, recent studies have shown that even women who have undergone the worst kind of FGM (did you even know there was more than one kind?) are still able to orgasm.
That oughta make circumcising girls better, right?
And actually, the Sorrells study shows that circumcision significantly reduces a man’s sensitivity, because it removes the most sensitive part of the penis. The foreskin is more sensitive than the most sensitive part of the circumcised man’s penis.
There’s science for you.
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“He can never know what he would have been with a foreskin, just as a person with one can never know what it was like to not have one.”
Sure, like a man with two working eyes do not know what it is to be blind, and so cannot tell if he would like it or not.
Seriously…
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You would assert that men cannot really know what they are missing and therefore have to legitimate basis for complaint.
Would you make the same assertion about women who were subject to a Type 1A circumcision (removal of the clitoral hood) as an infant?
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“There’s really no science behind what you are saying, and I hope you realize that.”
Look at yourself in the mirror, and say these words out loud.
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Exactly, so we are left with cultural tradition.
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“Sure, but is some evidence, not no evidence.” — When the researchers themselves admit that the data used is of poor quality, you should be hesitant of pointing to it as some big proof of lack of harm. You should know all too well how easy it is to create a study that claims just about anything, as long as you use poor-quality data. [Please note that *I* did not say that circ causes ED; I merely pointed out that you *very* conveniently stopped quoting the abstract before disclosing that the study authors themselves admit that the data was poor quality.]
If the data were primarily drawn from men who were recently circumcised (say, in the past two years), it’s entirely possible that there was little or no difference — but that doesn’t mean that ten years down the road, there will be no difference, nor that there is no difference between men circumcised as infants and intact men. Also, if the studies primarily looked at men who were voluntarily circumcised, they would have every reason to speak positively of their choice. Consider how many people are “happy” with their tattoos or body piercings or other body modifications for the first year or two or even ten or twenty, but eventually admit that they regret some of them or all of them. It’s entirely conceivable that a similar effect exists with circumcision.
Though I did not read every study cited in the footnotes/references of the above study, I would suspect that many of them dealt with adult male circumcision, which may yield different results from infant circumcision, and certainly does not speak authoritatively about what happens when an infant is circumcised. If you’re trying to give a reason for infant circumcision, and trying to say that infant circumcision doesn’t lead to sexual problems as an adult, then you need to cite only those studies which compare intact men to men who were circumcised in infancy.
Certainly, most men are very pleased with their sex organ; few men want to think of their penises or sexual experiences as inferior in any way to those of other men. Thus there is an inborn bias for men to rate their abilities as satisfactory — because they are satisfied, because they know nothing different — but it is possible that an objective test or objective questions may reveal some differences. For example, a man may claim that he has no sexual difficulties, yet if asked if he ever has difficulty having an orgasm, may admit to having such a difficulty on occasion — that it takes him longer to achieve orgasm than it did, but may think that it’s solely due to his age (a 50-y/o man can’t expect to have the sexual vigor of a 20-y/o), or that his wife isn’t as attractive at 50 as she was at 20, or some other excuse. But if the group of 50-y/o men who had been circ’ed as infants has greater *objective* sexual difficulties than a group of intact 50-y/o men, then we have a reason to suspect that perhaps circumcision plays a role in those difficulties.
The best study design would not be to compare men who were recently circumcised voluntarily to intact men, but to compare men who were circumcised as infants to intact men of the same age (and try to match them as much as possible in all other ways, health status, social status, culture, etc.); and to have as many *objective* rather than *subjective* questions as possible.
“Exactly, so we are left with cultural tradition.” — NO medical procedure should be undertaken for reason of cultural tradition. Medical procedures should be performed for medical reasons only, or if cosmetic, done because the patient requests it. Neither of these applies to routine infant circumcision.
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The burden of proof does not rest on the critics of circumcision, but on its advocates, because the default is to do nothing. There is no American research on whether circumcised men are more or less likely to experience PE, delayed ejaculation, ED. No research on whether their wives are more or less likely to experience vaginismus. There is no honest counting of botched or lethal outcomes. Hence American medicine has yet to do the due diligence needed to prove that RIC is relatively harmless. Hence RIC should cease forthwith.
Not all “cultural choices” are created equal.
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It all boils down to the fact that we should never ever remove any part of the body(weather is seems insignificant or not) on a child, unless there is a problem with said body part. Parents are always making medical decisions for their children, but there are limits and there should be. No other body part is ok to remove for “just in case” or parental decision. Parents can NOT remove any other body parts in the name of religion either. If someone said I removed the tip of my sons earlobe to honor our GOD they’d get in trouble and be deemed crazy. Surgery of any kind(no matter if it is minor or major) should ONLY be done IF a problem has occurred, and all other less invasive treatment options have NOT treated the problem, or if it is life or death. Circumcising a male infant does not fit into this category. PS… Some Muslims do circumcise their daughters at birth. Some do perform it at an older age(but they then also tend to circumcise their sons at an older age as well) . Many have their daughters clitoral hood(aka prepuce) removed… The girls keeps her clitoris. This is not much different than male circumcision. The males have their foreskin(also known as the prepuce) removed. There are several types of female circumcision.. The least invasive is cutting a small nick on the clitoral hood
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The issue here is that circumcision has always been illegal and a human rights violation. The 14th and FGM amendments outlaw ALL genital cutting of minors even for religious purposes in the absence of a medical emergency. Before these laws took effect, circumcision was implicitly illegal…not using anestesia and cutting off someone’s healthy genitals IS child abuse and torture. Many babies have heart attacks and aspirate on vomit as their tiny bodies go into shock. I am so glad you don’t miss anything BUT my husband at the age of 32 has little use of his penis due to alternating pain and numbness. His urologist says this is a direct result of his infant circumcision. Also the urologist says the recurrent prostate infections are due to the missing foreskin. It is appalling that anyone would suggest that circumcision is acceptable. P.S. check out where the foreskins go and also check out the rates of viagra and similar meds in high circ countries vs those who do not routinely circ. Also check out the rates of lube used during intercourse. Yep there IS a correlation.
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A “professional vagina expert/enthusiast” isn’t expected to understand, nor care about issues related to the sexual anatomy of human males. You are out of your element sir, perhaps this explains why you are so baffled.
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Some people claim that as a male gynecologist I must be out of my element discussing female issues. Now I’m out of my element discussing male issues! Apparently I have no element.
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Let’s not quibble with semantics.
Your field is in female genitalia and health.
You *are* out of your element discussing male circumcision, let alone performing it for your patient’s SONS.
Let me remind you that the woman you are seeing is your patient, not her son.
You engage in chalratanism and medical fraud.
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American male gynecologists could indeed benefit from more humility and more open minds.
All men are limited in their understanding of the female experience of sex. All circumcised men are limited in their understanding of the sexual virtues of the intact penis, for both genders. An American obgyn who does not appreciate both of these limitations is out of his depth.
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It seems to me that tolerance of the custom of circumcision is the position of greater open-mindedness than is condemnation.
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Would it be “open-minded” to tolerate minor forms of female circumcision? The AAP’s bioethics committe suggested that in 2010, before being forced to retract their statement six weeks later. Dr Diekema, the chair of the committee said “We’re talking about something far less extensive than the removal of foreskin in a male”.
Who’s looking after the rights of the child here? It’s their body after all.
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Jewish religion aside, the parental decision to circumcise a male child has nothing to do with parenting and will have almost zero effects on the parents. The only effects on the parent that I can think of is simply extra work to care for during recovery and extra cleaning in early childhood — in other words, no positive effects for the parents. Also, it effects the parents when there are complications. You mentioned that you thought this was rare but I would challenge you to spend 5 minutes on a forum for women who have given birth within the last year and see how many posts you can find about babies suffering from adhesions. You will find that it’s quite common — many having it ripped apart during dr appts or having additional surgeries to “fix”.
We know for certain that many men are effected by their infant circumcision. You can argue about where you think they should place that blame but the fact remains — there are plenty of men out there who are not happy about being circumcised at birth. Why is it ok for a parent to make an elective surgical decision for their child that has no impact on their parenting or their life? It only effects the son and most of the effect is on him once he becomes a sexually active adult.
You brought up religion outside of circumcision. However, if a parent does not bring their child into their faith, it would effect the parent’s daily life. That’s not the case with circumcision. Routine infant circumcision is simply altering a child’s body and taking away a man’s choice — as a parent who is completely unaffected. How is that OK?
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Men can miss their foreskins just like a fatherless child can grow up to miss having a father. Just the knowledge that part of your body was cut off can be alarming, even without the memory of it. If you were told that you were sexually molested as a child but didn’t remember it would that mean that you aren’t allowed to be upset by it?
The lack of a foreskin does effect sex. Just like the eye lid is to protect the eyeball and keep it moist, the foreskin is there to protect the head of the penis and keep it moist (among other things). With a dried out eyeball we can assume that your vision would not be the same as a person with an eyelid….but you wouldn’t know what you were missing since it’s all you’ve ever known. Also, women in America have for the most part, only had circumcised sex. I just assumed this was what sex was supposed to feel like. Rates of artificial lubrication are highest in countries with high circumcision rates. Know what else is high in those countries? Viagra…..though it typically doesn’t take effect until 50+ years old. An average penis contains about 24,000 nerves and about 20,000 are in the foreskin because the foreskin is meant to roll back along the shaft of the penis, giving the whole length sensations. So circumcised men are left with roughly 10% of the nerves they were meant to have…..that MUST effect sex!
Why do I care? Because I personally know three families who’s baby died from blood loss following his circumcision. I know one boy who lost the head of his penis during his. I know one man who developed an infection that spread to his brain leaving him mentally and physically handicapped. Every single one of these could have been avoided. I care because I watched a video of a circumcision being performed and have never ever heard a baby scream like that before…..and I never want to hear it again…..I’m glad men don’t remember it….
STD risk? Being circumcision does not provide you immunity from STDs….you must still wear protection. Since both intact and cut men must wear condoms then what’s the point?
Religious reasons? In what other way do we allow people to alter another persons body without their permission in the name of God? Do you feel it is okay for girls to be cut in the name of God? Many baby girls are having just a snip of skin removed for ritual at a few days old……should that be allowed? There are many practices in the Torah that are not practiced in our modern society. Animal sacrifice, stoning of women…..why have we decided against these but hold on to this disgusting practice? Just so you know, the original circumcision was only a tiny snip to allow for a few drops of blood, not the whole foreskin. Jews stretched their foreskins to cover the whole head to be allowed into bath houses by the Greeks who adored their foreskins. That’s when the entire foreskin was removed, so Jews couldn’t hide it anymore. You’re religion ends where another body begins.
I do know feel this is a parental choice….the foreskin is not a ticking time bomb…..there is no medical emergency…..so there is no reason to remove it. The people who choose to remove it do not know the many many functions of it or removal would never cross their mind.
We freak out over 40 deaths by a faulty crib and scream recall!!! Yet we do nothing when 100+ babies die every year from circumcision. It might seem like a small number to you but it means the world to 100+ families.
Visit http://www.questioncircumcision.weebly.com for a huge selection of links to every aspect regarding circumcision. It is my personal website with my many years of research.
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OMG. This blogger just doesn’t get it. He is so clueless on the fundamental issue of self-determination, sovereignty over one’s own body, the right to be whole, complete, intact, all of oneself. No rationalization here can cut it. I have read countless pretexts for circumcision, but this one ranks at the bottom for making a case. The blogger has an incredible insensitivity to the quest for humanitarian change in our species. Circumcision is repulsive in itself. Not the most well-meaning, loving parent should have the authority to order the excision of a living body structure from a child. This uninformed blogger has the audacity to suggest that adult circumcised males aren’t missing anything. Just wonder why Viagra and Cialis are so popular. The number of nerve endings, blood vessels and specialize components of the foreskin certainly have roles to play.
This woefully ill-informed blogger needs to suspend his writing until he get trained on research and has a modicum of medical ethics. What a botched piece of writing. People like him are sadly misleading parents to continue to perpetuate this disgusting torture of the helpless.
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To me we are using double standard, when we are condemning female circumcision and yet allowing and in a certain way, promoting male circumcision. This is part of a male’s body, there is no way to undo what the parents have allowed to be done. Regarding the the benefits with STD’s, well, if a 16 or 18 year old decides it is worth it, that would be his choice. But until then, he should at least have options. And if children are having unprotected sex before 16 or 18, what are the parents thinking anyway? And is circumcision really going to make a difference at that point?
I think this website sums up the anti-circumcision side in a more scientific way.
http://www.circumcision.org/foreskin.htm
http://www.circumcision.org/removes.htm
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The standard of care for pediatric surgery requires the medical benefits of the surgery to far outweigh the medical risks and harms or for the surgery to correct a congenital abnormality. Non-therapeutic circumcision does not even come close to meeting that standard of care. It is a clear violation of the principles of medical ethics that govern all other surgery on children.
The fact that Muslims and Jews believe male circumcision is a religious requirement is not a sufficiently good reason for our society to tolerate medical doctors cutting of a normal, healthy part of a non-Muslim or non-Jewish boy’s penis.
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I’ve noticed that Mexican women often pierce the ears of their female infants and place earrings in them. This is also a medically unnecessary procedure, but is culturally acceptable to most.
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Piercing a girl’s ears or even piercing a boy’s penis is a much less damaging form of permanent body modification than male circumcision. If you were to pierce a boy’s penis because his parents requested it for cultural or religious reasons, you would go to jail.
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When all else fails, change the subject, right Dr.?
Do you really think that piercing the ears of a child is akin to cutting his foreskin off?
No, piercing ears is more akin to giving a child a Prince Albert. If that’s what were happening, I’d probably be less inclined to protest, but I’d still be against it.
Cutting off a child’s ear lobes would be more akin to cutting off his foreskin.
What’s more, doctors are not offering ear piercings in their offices in the name of “health benefits.” If doctors were performing ear piercings, or even prince alberts in their offices at parent’s behest, they would surely lose their jobs.
For the record, I am against the piercing of children’s ears too. If doctors were performing them for patients, you would bet I would be at the front of that line.
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Drawing an analogy is hardly changing the subject.
Strangely, I also find the piercing of an infants ears distasteful as well. It strikes me as vanity on the child’s behalf.
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Ear piercing removes no tissue, and will reverse itself if the owner chooses to leave the rings out. Piercing a child’s genitals is illegal.
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“I also find the piercing of an infants ears distasteful as well. It strikes me as vanity on the child’s behalf.”
And isn’t cutting part of a chld’s genitals off also vanity – especially if it’s “to make him look like me”?
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Lawn — Sadly, the reason this blogger wears such a heavy veil of indifference is because he is an obstetrician who performs circumcisions on a regular basis. In order for him to continue this unjust procedure day after day, he must very heavily convince himself that it is “no big deal.” Additionally, since he himself was circumcised it would be an enormous feat to step outside his comfort zone of his beliefs about his own body. As you say, the unfortunate thing is that through his efforts he is perpetuating this practice in America. Parents need to hear their doctors convincingly state that it is completely unnecessary – or better yet that he is unwilling to provide the service. If doctors had the sense to do this, we would quickly see an end to routine infant circumcision in this country.
Honestly, Dr. Fogelson, I really appreciate your blog, but you have greatly missed the mark on this one. You blame circumcised men for actually taking the time to research what is missing from their bodies. You shun the idea that there is any scientific evidence that there are beneficial physical properties to a foreskin. And, you minimize the potential risks associated with the procedure, while throwing in a couple of vague references to the heavily-promoted half-truths about STDs and penile cancer (neither of which afflict newborns, and arguably have nothing to do with circumcision). My guess is that you have never thoroughly researched the topic. Why not start by having some conversations with the DOC doctors? Their library on the topic is extensive.
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We can’t all agree on all issues. I don’t think there is a ‘mark’ on this one. It is a grey area and many wise and ethical people think differently.
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Forced non-therapeutic genital cutting a grey area issue? I guess if you dont believe males and females deserve equal treatment under federal law and international human rights declarations. Should someone who was surgically altered without a medical diagnosis, at a time when they could not consent, be allowed legal avenue to hold the physician accountable for his actions? This is an important issue, for sure.
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Such lawsuits have been brought. I heard of it happening twice, and in both cases it was quickly thrown out by the judge. In order to commit negligence one has to breach the standard of care, which is clearly not being done here.
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Or so you would like others to believe.
Correct me if I’m wrong, Dr, but isn’t it true that no medical organization in the world, not even in the US, recommends the circumcision of infants for “medical benefits?”
Lo, they all state that there isn’t enough evidence to recommend it. Yet, they still step back and pretend like it’s a “parent’s choice.”
Think about it. There is not enough evidence for any major medical organization to come to any reasonable conclusion. And yet, parents, most of whom have never even picked up a textbook on basic human anatomy (not that it would do them much good in America, where the foreskin is usually absent, or the only time it is mentioned it is in the context of circumcision), are expected to take the exact same “evidence” and somehow come up with a better conclusion?
There is no “gray area” here. Male circumcision is clearly out of your league. The only reason you can get away with surgery in male children is because our country graciously looks the other way.
You are being disingenuous presenting male circumcision as this “ongoing debate.”
The trend of opinion on routine male circumcision is so overwhelmingly negative in industrialized nations that it would be quite surprising were male circumcision to be recommended in the United States. No respected U.S. based medical board recommends circumcision for U.S. infants, not even in the name of HIV prevention. They must all point to the risks, and they must all state that there is no convincing evidence that the benefits outweigh these risks. To do otherwise would be to take an unfounded position against the best medical authorities of the West, within and outside of the United States.
You, sir, are insulting your readers’ intelligence.
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Yes, good people will disagree, but what baffles me is why you believe it is appropriate for doctors to engage in this process at all? It takes some pretty heavy mental gymnastics to convince oneself that it is “reasonable” to remove a healthy body part from a newborn baby, simply because parents request it. The justification that you have used is “most men in my generation had it done, the US accepts it culturally, and it was done to me and I’m fine.” So you really believe that this is adequate justification for a medical doctor to perform an unnecessary surgical amputation on an non-consenting patient? Isn’t medical practice supposed to based on science and not cultural preferences?
Many (if not all) body parts have the potential to become infected or diseased during a lifetime, yet we don’t start removing them from a baby to protect them. From a medical standpoint, do you believe that the foreskin is more likely to malfunction than other body parts? I also wonder if you are aware that there are several physical functions of the foreskin? Again, if it is only “cultural” reasons that make this practice acceptable, why is it alright for medical doctors to participate? Truly, it defies logic and makes me question the integrity of our medical system.
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So Dr. Fogelson has settled it. He rationalizes that we can’t agree, so he has the license to go on doing what he’s been doing, dismissing the fuss about circumcision as “oh, that’s just those who protest too much about nothing.” This is how injustice and tyranny continues. The fact that babies in notable numbers die, triggered at least by the circumcision, should disturb him. That botched circumcision, tags, etc., bring lifelong problems for male should disturb him. Yes, we know he is in the business of cutting so he is already compromised. Sadly he lacks the curiosity to really investigate circumcision. Sadly he lacks the courage to change his professional ways. The fact that many males DO RESENT having been violated, having had penile reduction, having had the movable part of their erection eliminated, having had those nerve endings denied them ought to give Fogelson reason to question the ethics. He dismisses it as entrenched culture, so that OK. So was domestic violence, smoking in the workplace, off-color comments in public settings, slavery, et nauseum. Wake up, folks, and recognize sexual assault on the helpless.
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Sophia, I am with you. I am simply dispelling the myth that female circumcision is “different” because “no women look at it as being a good thing”. Just like some males consider their childhood circumcisions to be a good thing, so do some women. Neither makes it ok. It’s time that we have gender equality on this issue.
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Ethical doctors say NO to circumcision.
“Non-therapeutic circumcision of male minors is contrary to the rule that minors may only be exposed to medical treatments if illness or abnormalities are present, or if it can be convincingly demonstrated that the medical intervention is in the interest of the child… Non-therapeutic circumcision of male minors conflicts with the child’s right to autonomy and physical integrity.” ~ Royal Dutch Medical Association
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I am curious, do you preform and profit from circumcision? I beg you to continue research on the issue, for your future son’s sake.
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If you have a space 33 minutes, you should give this presentation at Georgetown U a watch – http://vimeo.com/26130057
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Thank you for sharing this video. I watched it with interest.
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I did many circs as a resident, but have not done them since because in the hospitals I have worked in they have been done either by our residents or by pediatricians. We do get paid to do them, though it is not a great amount, perhaps a hundred dollars depending on insurer. As a resident, I certainly had no incentive to do them, and was happy when there were fewer to do because I got to sleep in!
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Are you seriously going to pretend like doctors do only one or two a day?
1.3 million babies are circumcised a year. At a dollar a head, that’s already 1,3 million dollars.
Now let’s consider circumcisions don’t cost a dollar.
You must think your readers are seriously that stupid.
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No, you are misinterpreting what I said. I was referring to my specific medical group, not the entire world.
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“There are plenty of data to suggest that circumcision decreases horizontal transmission of some STDs and the rate of penile cancer, though these effects are small. The anti-circumcision folks like to act like this data doesn’t exist, but this is just their ignorance.”
Anti circumcision ‘folks’ don’t deny these datas but point out that these studies are very debatable. For example the very idea that circumcision can decrease HIV comes from a jewish doctor, Aaron Fink. If circumcision has so many advantages you have to explain me why the rest of the world is just doing fine without circumcision ? Why in Europe there isn’t more cases of penile cancer, AIDS etc ?
Also keep in my mind that circumcision was introduced in the US to stop masturbation. It had nothing to do with STDs, cancer or hygiene, these poor excuses came pretty recently.
“Its pretty obvious that by 18 years old, very few boys are going to choose to have their foreskins removed.”
I agree. There is a reason why most uncircumcised boys do want to keep their foreskins. Fear of surgery isn’t the only reason. Pushing infant circumcision because most intact adults do want to keep their foreskins is a very bad idea.
“I hear stories from various anti-circumcision activists about how men are traumatized by their lack of foreskin”
I have been involved in intactivism for a few years and I’ve never heard this kind of anecdotal evidence. Most of these unhappy men did experience lack of sexual pleasure when aging. Foreskin restoration have helped many guys, including myself.
“Everyone is free to circumcise their child or not, and the boy will grow up just fine either way.”
Everyone is free to circumcise himself the exact same way some women are choosing labiaplasty for themselves. The very fact that there is now a decent number of men against this needless procedure clearly shows that the decision should be up to the child when he’s old enough to do so.
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You are an OB/GYN.
You deal in *women’s* health.
Precisely WHAT are you doing giving your opinions on MALE CIRCUMCISION, let alone PERFORMING it in healthy, non-consenting individuals?
What a shame that OB/GYNs are allowed to cash in on a procedure that’s NOT EVEN IN THEIR FIELD, and professional American organizations, not to mention our judicial system, looks the other way.
SHAMEFUL.
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The alternative would be pediatricians, who are less trained in surgical skills, or urologists, who are not usually available. OB/GYNs do them because they are routinely around the nursery and have the surgical skills required. Pediatricians and family physicians do them in some hospitals.
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An even better alternative would be for all doctors to put down their knives and to respect a male’s right to decide for himself when he is an adult what permanent body modifications are done to his own body.
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Dr. Fogelson,
You said a man cannot know what he is missing. He can. My father was the son of immigrants and not circumcised. At the age pf 28, he decided to be circumcised–unfortunately, he made an ill informed decision based on American culture. He regretted it–he wished he never had the surgery. The man knew exactly what he lost, but too late!
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You make a very valid point. I think though that your example is the exception to the rule. Most males circumcised in this country are circumcised at or near birth.
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You’re in a river close to Cairo now. Here’s an example of what someone in these discussions invariably calls for – someone who’s tried it both ways,
* who didn’t need it because his sex was sub-optimal or his foreskin malfunctioning in some way,
* who wasn’t expecting “spiritual benefits” from it,
* who didn’t do it for kinky thrills.
If a single example can count for anything, this one can. Circumcision impaired his sex life (just as a recent study in Denmark found it does.) Accept the obvious: If you cut a richly innervated, stragetically placed, uniquely mobile,part off a sexual organ, the pleasures of sex are impaired. It’s any other outcome that should be surprising. When it was introduced, non-religious circumcision (and religious, for all anyone knows) was INTENDED to impair sexual pleasure.
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Nicholas you imply children do not have the same human rights as adults, this is not so children have all human the human that adults do. Since children have the same human rights as adults they have to be free from harm, they have the right to body integrity and so forth. Now it is true that a parent or guardian may consent to medical treatment for a child even ones that damage the body but the consent is only valid when there is a present issue that needs to be dealt with or a probable issue that can be prevented with a particular treatment. There are some minor benefits from circumcision however you could say that about removing many body parts. Tonsils, gallbladders, and appendixes cause far more problems than foreskins yet we don’t allow parents to remove those unless they are causing problems. With STDs condoms are 99% effective at preventing a teenage boy or man from being infected with an STD and at best circumcision could add another .99% protection. As far as penile cancer that is one of the rarest cancers only about 1 in 100,000 males will get it making it more rare than male breast cancer. The primary risk factors for penile cancer are smoking and unsafe sex, so a better what to lower a child risk of penile cancer is to teach them to not smoke and to practice the ABC (abstinence, be faithful, and condoms) method. Saying that it is impossible to know if circumcision reduces sexual pleasure is like saying it is impossible to know if doing the equivalent of a male circumcision on a girl or woman will reduce her ability to sexual pleasure. No one is saying that the foreskin is the only part of the penis that provides pleasure, what is being said is that it provides the most pleasure. You wouldn’t use that argument to tell someone who had a birth defect where part of their legs didn’t developed that their longing to have complete legs was an invalid feeling. You say that people circumcised so early they have no memory of that time are not traumatized shows a lack of understanding of trauma. If a child age 1-4 is raped that can cause trauma even if the child cannot remember as conscious memory of an event is not always needed for trauma to occur. Males who are circumcised as children are 60% more likely to suffer from Alexithymia and one of it’s causes is psychological trauma. Many boys and men become hurt and angry upon learning what happened as their right to choose if they wanted to be circumcised or not was taken from them needlessly. Many boys and men (more so men in this case) become hurt and angry because causing the equivalent amount of damage of a male circumcision anywhere on the male or female body is not allowed unless it is medically necessary or an adult consents to it. Grievances like these are valid so when boys and men become angry with people who have or do perform circumcision and parents and guardians who had the circumcisions performed those feelings are valid no matter how much you would like those feelings to be invalid.
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We can certainly argue about what rights a child or infant has, but I think its pretty clear that children do not have the same rights as adults. Parents exert their will on their children in any number of ways. Some feel that circumcision is an unjust part of that exertion of will, others feel that it is a reasonable choice given its cultural and clinical context. While the commenters on this post are certainly passionate, there are a lot of people who disagree with that point of view who are either not reading this post or choosing not to comment. I’ve heard from several such people already, who choose not to enter the melee. I happened to look at another post at Huffington Post and noticed that the ration of pro/con in the comment stream was about 50/50 unlike the 99/1 we see here. It just depends on who’s reading.
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I’m tired of medical doctors trying to masquerade a stone age form of tribal body marking as a valid medical procedure in the twenty-first century. Cutting off a normal, healthy part of a child’s body when there is no medical indication for the surgery is not “a reasonable choice” according the principles of medical ethics.
There are effective, non-invasive ways to prevent and treat the medical problems that male circumcision is supposed to prevent. The principles of medical ethics require doctor to use effective, non-invasive methods of prevention and treatment first, before they use surgery.
“Current understanding of the benefits, risks and potential harm of this procedure no longer supports this practice for prophylactic health benefit. Routine infant male circumcision performed on a healthy infant is now considered a non-therapeutic and medically unnecessary intervention.” ~ College of Physicians and Surgeons of British Columbia
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It certainly depends on the audience, and since so many parents in the U.S. consent to circumcision every year it would be irrational to think that there are few supporters, there are many – unfortunately.
Children’s rights are in some way different but not fundamentally. The U.S. is the only country except Somalia which has not ratified the Convention on the rights of the Child. Is it not largely due to the fear the parents would loose the control? And on a side note, to my knowledge Somalia is the country where female circumcision is extremely common.
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It is clear you are confusing human rights and privileges. Rights by there very nature are inalienable and they and apply to all people equally no matter their age, gender, religion ethnicity and so forth. A privilege in contrast is the opposite of a right it is alienable and it does not apply to all equally. So either it is a right of all males to genital integrity or it is not. The answer of is it a right or not lies with females’ human rights. We consider any unwarranted damage of a females genitals by another to be a violation as it is an infringement upon their human rights. Since rights are nondiscriminatory males must also posses the same exact rights as females.
What is right and what is wrong is not changed by public opinion only the perception of right and wrong are from time to time changed. So it does not matter how many people believe unwarranted circumcisions are right or wrong as the practice by its very nature is a violation of human rights so it is wrong.
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I appreciate the comment, but respectfully disagree. I think that ethics do evolve over time with society. Things that are abhorrent in one context may be allowable in another.
A common example of a moral absolute is “It is wrong to murder someone.” Seems simple. But then what about in war? Now the absolute is undermined.
Various forms of body modification and decoration have been prevalent in human society for all recorded time, even in fossilized remains in some cases. In many cases this occurred in children beneath the age of consent. Do we pass judgement that for thousands of years of humanity was immoral? Perhaps you do, but I do not. Societal folkways and mores change over time. Perhaps there is a change underway that will ultimately lead to the end of male circumcision, but this will not be a sudden realization of the moral truth. It will be one more piece of the evolution of society.
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Ethics and morals are not the same as what is right and what is wrong as they are a person’s or a society’s perception of right and wrong and perception is not always the same as reality. A good example of this is in the early 20th century after non-therapeutic male circumcision had become established in Britain and the United States some doctors started promoting female circumcision in research articles such as WHY NOT CIRCUMCISE THE GIRL AS WELL AS THE BOY? by Belle C. Eskridge, M.D. and Circumcision in the Female Its Necessity and How to Perform It by by Benjamin E. Dawson, A.M., M.D. and performed them on minors and sometimes even adults. The fact people found it ethical and morally ok for doctors to perform non-therapeutic female circumcisions does not diminish the fact that non-therapeutic female circumcision was wrong.
As for your example the notion that murder becomes less wrong during war times that is a perception that does not change the fact murder by it’s nature is wrong as it is the selfish robbing another of their life. I must stress murder is not the same as killing another person as those who kill but do not murder are not doing so for completely selfish reasons. I suspect you are thinking about something like someone killing someone to save someone. The act of saving someone is a good act none the less taking a life is still wrong. In many societies that have come and gone and are still around today the saving of a life is seen as a payment for the wrong act.
You are correct society’s perception of right and wrong is slow to change with change sometimes taking decades, centaurs and even millenniums to occur. With that said male circumcision won’t ever end even non-therapeutic circumcision of minors. What can happen is male circumcision is seen by society to be a choice for adults and to be a crime when non-therapeutic circumcisions are done to minors, those who cannot consent and those who do not give consent.
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The rights of chilldren vs adults are almost irrelevant here, because circumcision is almost irreversible, so what you do to a child, you do to the adult he will become. The claimed health benefits of circumcision mostly (cancer, STDs, HIV) are inapplicable before adulthood, and the other main one, UTI, would require hundreds of circumcisions to prevent one case (by circumcision advocates’ own figures) which can be readily treated as and when it occurs.
What other people say on other fora is irrelevant, and what they don’t say, even more so. It is you we are arguing with, and you who are failing to answer us.
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“In many cases this occurred in children beneath the age of consent. Do we pass judgement that for thousands of years of humanity was immoral?”
Well, do we pass judgement that for thousands of years, slavery was immoral? Or do we continue to allow slavery because to do otherwise would be to judge thoursands of years of humanity as immoral? Since our judgement of the past makes no difference to the past, this question seems to be a red herring.
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“Perhaps there is a change underway that will ultimately lead to the end of male circumcision, but this will not be a sudden realization of the moral truth. It will be one more piece of the evolution of society.”
Like other stages in our ethical evolution (like the recognition of the immorality of slavery and child labour, and the rights of women to equality) it will take time, but it will not happen by itself. It will happen as one by one, people are convinced. They will be convinced by the power of reason and a certain amount of emotion. Some of the issues are shown in this diagram: http://www.circumstitions.com/Images/meme-int.jpg
As more and more people are convinced, the effect will snowball. This evolution is happening here and now.
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“…I think its pretty clear that children do not have the same rights as adults.”
Children have the right to have their sexual organs not modified for cultural of cosmetic reasons.
“Parents exert their will on their children in any number of ways.”
This power can be abused. Infant circumcision is a case in point.
“Some feel that circumcision is an unjust part of that exertion of will, others feel that it is a reasonable choice given its cultural and clinical context.”
Why do American doctors enable parents in this fashion? Why is “culture” a valid reason for a doctor to intervene? Why were millions of infant boys circumcised last century without prior consent of the parents? What does “clinical context” mean here?
“…there are a lot of people who disagree with that point of view who are either not reading this post or are choosing not to comment.”
This is Richard Nixon’s “silent majority” argument. What you are saying here is a truism that sheds no light. The point is this. Why should doctors alter the penis of a minor, in a way that cannot be undone, simply because his parents want it to look different? Should a man not have the final say in how his penis looks and functions during sex?
“I happened to look at another post at Huffington Post and noticed that the ration of pro/con in the comment stream was about 50/50 unlike the 99/1 we see here. It just depends on who’s reading.”
True, but so what?
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Fogelson gives us the classic example as to why justice is so difficult to achieve. Research, logic, human rights and reason don’t work with people like him. Tribal culture trumps everything in his way of thinking. Notice how he slips around the fundamental issues of self-determination and inherent rights to sovereignty over one’s own body. We must slog onward through the dark bog continuing to bring pain, suffering and physical violation to helpless little people because of of quack medicine. Fogelson strives to be an apologist for a lame practice that if concocted today would be quashed as macabre insanity. One of the best developments have been the work of young women and mothers on Facebook and the Internet to courageously speak out in so many creative ways. We need to use lawsuits, shame, activism, education, boycotting hospitals, demonstrations, et al to put these troglodyte circumcisers out of business. I fear Fogelson is a lost cause. He doesn’t grasp the fundamental right to be safe in one’s own body from the intrusion and snatching away of what God/nature gave them. I thank all you earnest, robust, articulate folks trying to bring him to his senses. We are saving males from the rude, crude indignity of circumcision.
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+1
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+1,000
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Lawn Griffiths was one of the very very few Americans to disagree with routine infant circumcision in the 1970s. I admire him greatly for that.
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When did I realise this isn’t normal? When I was about 5, I observed most boys in my class weren’t like me, as circumcision almost exclusively religious in my country (My family aren’t Jewish or Muslim) plus my second brother was born around this time, and he was left intact. I only learned this year that my two youngest brothers were allowed to keep their penises in their proper state because of money issues, and that my mother was dead against circumcision, but eventually gave in to my father’s demands.
To return to a point the author made, I’m very much against the procedure being done on infants. If this includes ritual circumcision, then so be it. I’m sure some people would accuse me of having some sort of racist agenda, but this couldn’t be further from the truth. I simply can’t condone this kind of thing being done to a child. Mr. Fogelson says :”It’s pretty obvious that by 18 years old, very few boys are going to choose to have their foreskins removed.” This is probably the greatest argument as to why it SHOULDN’T be done to children. It seems awfully sinister, doing it to babies for no other reason than they haven’t the strength to defend themselves or the ability to argue. I would be very interested to see in a world where infant circumcision is completely outlawed, just how many grown men would subject themselves to the procedure voluntarily. Not many, I’d imagine.
As for complications, I’m all too familiar with them. In the past I’ve been asked by partners what was wrong with my penis. I’ve recently come to learn that the abnormalities are called “skin bridges”, previously, I didn’t even know there was a name for them. Smegma gathers beneath them, but instead of simply retracting, then washing, which is what I’d do were I…unmodified, I have to poke out the smegma with a paperclip, a most annoying task. And here I thought circumcision was meant to be cleaner. There was no medical or religious reason for me to be circumcised, it was done simply for reasons of paternal arrogance. Women asking me if I’m Jewish does get rather tiresome, as do the questions which always follow when I reply negatively. If i could make my penis normal again, I’d do so in a heartbeat, but short of a scientific leap in tissue regeneration or time travel, or finding a magic lamp, I don’t see that happening. It’s easier to destroy than create, and sadly this is especially true where infant circumcision is concerned.
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Newsflash! Interfering with the sexual organs of children without need is wrong. Restraining children and excising healthy living tissue from their body is wrong. Two wrongs do not make a right. Forced circumcision is very, very wrong.
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Excuse me!, the “large” part of the world you are refering to is only about 20% of the male population. That leaves the remaining world of intact male population at 80%.
While “data” exists, the odds of a man getting breast cancer is greater wich is almost NEVER, than the odds of penile cancer.
As a future ordained minister, I suppose it is my “cultural right” to strap newborns down and “trim” their ear lobes. If it is what I and my followers believe, then It would be OKay. The newborns will become adults and carry on with “normal” life without ear lobes (foreskin is so much more complex than ear lobes). In fact, it must be my cultural right to cut and remove any area of a human being as long as it doesn’t affect their ability to think and take care of themselves of course.
I feel that based on the “data” regarding STD transmission, That as a circumcised male, the need to practice safe sex isn’t nescessary. So why does the United States have the highest rate of H.I.V. transmission of all the industrialized countries, and also the greatest percentage of circumcisions? Don’t say it is a “gay thing” in the U.S. because their are plenty of “gays” throughout the world population, most of them intact.
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A large part of the world feels that male circumcision is a reasonable thing to do, whether they are circumcised or not. Another large part is casually against it but doesn’t think its a big issue. A very small part of the world is of “intactivist” nature.
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Many people are very surprised to discover that only around 1% of the world’s male *infants* are subjected to forced circumcision. The vast majority of circumcisions across the world are ritualistic / Islamic and happen to older boys. Fact is, unless you’re born into a Islamic or Jewish culture – or in America or Israel – it’s highly likely you will have a complete and normal set of reproductive organs.
I believe much of the world is ignorant to America’s genital cutting practices and would be horrified to learn that so-called healers are partly amputating the penises of around a million healthy baby boys every year.
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Many of those who do not think “it is a big issue” do so because they are living in places where circumcision is uncommon and they can’t imagine what is actually happening in the U.S. And also since it is something uncommon for them they are likely not to have a need to be educated about the negative effects of performing something they do not do in the first place.
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A large part of the world feels that (all) circumcision is a very bizarre thing that remote other people do. It is only thanks to the Internet that it has become common knowledge in the rest of the developed world that they still do it (to males) in the USA. And the part of the world that is of Intactivist nature is certainly growing. When I began on dailup message boards 15 years ago, I knew virtually all of those who agreed with me, and we were greatly outnumbered. Our persistence is slowly paying off. The Internet is also empowering men who were harmed by circumcision to make it known. They’re as mad as hell, and they’re not going to take it any more.
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A large part of the world also believes that female circumcision is a reasonable thing to do. It’s why they do it.
I’m afraid cultural relativism is not going to save you here.
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For most of humanity, circumcision is not an issue. Hence most men and women never give it any thought.
Not many intact men agree that circumcision is a reasonable thing to do.
It is in the natural order of things that intactivism will emerge only in cultures where circumcision is the norm or is otherwise controversial: USA, Canada, Jewish families. This means that intactivism will not be all that common around the world. In no way can that fact be construed as a critique of intactivism.
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Sigh… You seem to be working on the assumption that it’s just a flap of skin designed to protect the glans. The inner foreskin is in fact far more sensitive than the glans. That’s why this whole thing is a big deal. Even on a circumcised man, the glans isn’t the most sensitive part (it’s normally the scar line, or the frenulum if that wasn’t removed). You’d probably think it was unethical if a parent wanted their child’s earlobes to be removed, but I’d be a lot less bothered by that than I am about male circumcision.
“I can say that from a personal point of view, everything down there seems to work just fine.”
Good for you. Did you see the Danish study by Frisch et al though that concluded:
“Conclusions Circumcision was associated with frequent orgasm difficulties in Danish men and with a range of frequent sexual difficulties in women, notably orgasm difficulties, dyspareunia and a sense of incomplete sexual needs fulfilment. Thorough examination of these matters in areas where male circumcision is more common is warranted.”
“Everyone is free to circumcise their child or not, …”
Not if that child is female. It’s illegal to cut the prepuce off a girl or even to make a pinprick down there. Why don’t boys get the same protection?
“and the boy will grow up just fine either way.”
There are probably a lot more men than you’d think who are very unhappy about having been circumcised. It might be convenient for you to dismiss them as crazies, but remember that in countries where they cut girls, they are usually similarly dismissive towards women that complain about it.
“Male circumcision is a cultural rite performed on newborns.”
There are only two countries in the world where more than 50% of newborn boys are circumcised – the USA and Israel. There is no reason not to let people choose for themselves.
“Its pretty obvious that by 18 years old, very few boys are going to choose to have their foreskins removed.”
Doesn’t that suggest to you that maybe it’s not a good idea to do it to them before then? If almost no-one would choose to be circumcised, then why deny them the choice?
I’d pay a year’s salary rather than be circumcised, and I’d do the same for my son. If our son wants to be circumcised when he’s 18 though (16 if he knows what he’s doing), I’ll pay for it and help him find a good surgeon. Until then, he stays intact. His body – his decision. If he wants to be circumcised later, it’s easy to fix – safer, less painful, and better cosmetic results. If we’d had him circumcised, and he wanted to be intact, it’s a problem.
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Let’s get to the bottom of your arguments:
1. Because a male circumcised at birth never gets to experience whole genitals, he’ll never know the difference. — So does this mean it’s OK to do something to someone, right or wrong, as long as they don’t know the difference? If a woman is fondled or sexually assaulted by a health care provider while she is under anesthesia, is that OK since she will never know the difference? And if someone tells her and she gets angry at the HCP, would you say that her blame is “misplaced” and that she should instead place blame with the person who told her? After all, she never would have known otherwise.
2. Parents exert their will on their children in a number of ways. — OK, well if a parent brings a 16 year old, or a 9 year old or even a 5 year old in to the doctor and asks for a completely elective circumcision to be performed on him even if the child is saying he doesn’t want one — is that OK? Because after all, parents exert their will on their children. Or, is it ONLY “ok” when the child can’t speak for himself? If so, there is a big problem with your argument. If a 16 year old, or a 9 year old or even a 5 year old says they don’t want to go to school, the parent still has the “ok” to exert their will upon them.
3. A large part of the world feels that circumcision is a reasonable thing to do. — can you prove this? Because I don’t agree that this is the case – seems like only a small part of the world feels it’s reasonable. Also, even if it were, is that the measure of whether something is OK or not? At one point, a large part of the world thought that slavery was a reasonable thing to do.
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“It would make far more sense for them to be angry at the person who felt the need to drive a message into one’s head they were somehow incomplete, a message without which the feeling of loss never could have occurred.”
Not a “message” which anybody needed to “drive” but a conclusion which many men come to by their own reasoning powers. Men such as these: http://www.circumstitions.com/Resent.html
In Jewish tradition, circumcision is done as a way of honoring … a covenant which commanded that all of Abraham’s sons and male servants [be circumcised],”
Slaves actually, and “everyone in his household”. Does that include the live-in Mexican gardner?
“I would feel a cultural desire to circumcise my son when and if I have one.”
A cultural desire, or anxiety about having a son with a diifferent pensi from you? (And MORE penis than you.)
“Parents make all kinds of decisions for their children that shape who they will be, least not of which is the teaching of religion. The instillation of a belief in god is an almost irrevocable and life changing alteration to a person’s frame of reference,”
Yet you imply that you managed to shake it off.
“I just find it odd that people give a damn about what others do in this regard.”
How about giving a damn about fellow human beings having a normal, integral, healthy, functional, non-renewable part of their bodies cut off without their consent? (Who does it isn’t of any consequence – for the first half of the 20th century, doctors often did it without asking parents.) The male foreskin is the only such part it is even legal to cut off without pressing medical need. Why the anomaly? The female foreskin (clitoral prepuce) has Federal protection. Why the double standard?
“Its pretty obvious that by 18 years old, very few boys are going to choose to have their foreskins removed.” An EXCELLENT reason for not doing it before they can choose.
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What’s the difference between Dr Fogelson using his tools and training to safely remove a healthy child’s foreskin at the request of a parent and a doctor in an Indian village using his tools and training to safely remove a healthy child’s eye / hand / foot at the request of a parent?
While the parent may fully believe the request to be justified (whether it be to shape the child’s penis into a form the parents find attractive or to make the child a more effective beggar), any doctor who takes a blade to a healthy child is acting unethically.
There is no logical or moral justification for medicine to treat the genital region of a male child differently to any other body part.
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To me it seems those advocating for infant circumcision have very little if any facts but a lot of beliefs. Among those, who use reasoning, science, ethics and moral as the base for their arguments “pro-circumcision” can never “win”. Everyone here has raised similar questions about rights of the child, ethics, moral, equality. I do not see how those arguments can be “defeated” using logic, science, ethics, and moral arguments. And it appears that community here won’t take anything less than that. May be this is the reason why the other side is silent in the discussion here?
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I think that it surprises me how ambivalent you are to the issue. The medical benefits are sketchy, and it’s a permanent change to a child’s body. I understand somewhat why those of the Jewish faith feel the compulsion to circumcise, but most in this country are not Jewish and are doing it because they are not informed of what the Bible actually says (it’s not required or even advised), or what the potential consequences could be for their child immediately, and in the future.
I personally don’t see a difference between male and female circumcision; they are both done for similar reasons, mostly religious. Most babies live through the procedure, but their lives are changed by the decision that their parents made for them. Some babies die, and others have complications that would have been totally avoided without the procedure.
Parents do have a right to make decisions for their children, but I don’t understand why circumcision is viewed differently than other surgical cosmetic procedures, most of which are not performed on babies/children unless there is a real immediate benefit. (for instance, birthmark removal on children’s faces).
There just seems to be a real double standard.
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You’re right that there is a double standard, though the true equivalent of the radical female circumcision that the world abhors would be cutting the entire penis off.
I think the difference though, is that male circumcision is a cultural tradition that originates in a religious mandate, while female circumcision originates in male domination of women, and a desire that they not enjoy sex. One originates in a sign of faith, and the other in misogyny.
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Most female “circumcisions” do considerably less damage than the usual western form of male circumcision though. Just look at what the doctors in Egypt, Malaysia, Indonesia etc do. Even a pinprick is banned on a baby girl in the USA though.
The rise of circumcision in the USA has nothing to do with religion, but in some seriously misguided medical opinions. Most people in the USA are Christian, but in the most Christian countries in the world (places like Mexico, Poland, Brazil, Spain, Italy), circumcision is almost unknown.
No-one except for Muslim and Jewish people would even be having this discussion if it weren’t for the fact that 19th century doctors thought that :
a) masturbation caused various physical and mental problems (including epilepsy, convulsions, paralysis, tuberculosis etc), and
b) circumcision stopped masturbation.
Both of those sound ridiculous today I know (I thought that argument was bogus too when I first heard it), but that’s how they thought back then, and that’s how non-religious circumcision got started. If you don’t believe me, then check out this link: http://www.noharmm.org/docswords.htm
Heck, they even passed laws against “self-pollution” as it was called.
Over a hundred years later, circumcised men consider it “normal” because it’s happened to them and most of their peers, and they keep looking for new ways to defend the practice.
The strongest defenders of female cutting are not men but cut women btw, and they claim the same reasons to promote it (health, hygiene, cosmetic, religious, etc).
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Here are reasons for female genital cutting given by those who do it: http://www.circumstitions.com/FGC-stitions.html and they are just as wildly varied and irrational as those for male genital cutting. In the USA and most of the developed world, ALL non-therapeutic FGC is outlawed, no matter how minor, surgical and pain-free, and with no exemption for religion or culture. There’s the double standard.
Advocates of male genital cutting – Maimonides for the religious variety, Kellogg and Remondino for the “medical” – all advocated it as a way to make sex less enjoyable.
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Not exactly. There are many kinds of female circumcision, some which are equivalent, if not less severe than infant circumcision. Two years ago, the AAP tried to approve a “ritual nick,” and they admitted that this would be far less severe than male circumcision. Little oversight the AAP committed: ALL genital cutting is deemed “mutilation” in this country.
No, female circumcision is also a cultural tradition that is a religious mandate for the people who perform it. No, female circumcision is performed by women on women because it symbolizes “purity,” and makes a woman attractive in the eyes of a suitor. Not that different than people arguing that circumcision makes a boy’s penis “more sexually attractive.”
You also seem to forget that male circumcision was encouraged in this country as a way to stop masturbation. The origin of circumcision in this country is one of deliberate misandry.
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You can’t judge all cut men by your own experiences, though I’m guessing you are in your 20’s (wait 20 years and then write another article on how happy you are with no foreskin). No two circumcisions are the same. Some men lose too much and have painful erections, or they have skin bridges or numbness. That has NOTHING to do with an intactivist planting doubt in their minds as you speculate. All cut men have the right to be angry. If they’re not, that’s fine too. But every single one of you had something taken away from you against your will.
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You’re right that there are rare issues, which is why they need to be done by trained surgeons.
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In most countries where female cutting is done, it’s performed by trained surgeons with real medical degrees in real operating theaters. That doesn’t make it right.
It’s not really the “rare issues” (some of which aren’t that rare, like meatal stenosis) that make circumcision ethically questionable, but the fact that even if a male circumcision is performed perfectly, the “patient” has had the most sensitive parts of his penis removed. I know you probably think that’s BS, but why do you think that maybe 98% plus of intact men want to stay that way?
What’s wrong with letting people choose for themselves whether or not they want parts of their genitals surgically removed? It’s their body after all.
It’s very very rare, but there are several documented deaths of babies following circumcision by trained surgeons btw. Having a surgeon perform the operation rather than just the nearest person with a medical degree reduces the risks, but does not eliminate them.
You might want to check out the following:
Canadian Paediatric Society
http://www.cps.ca/english/statements/fn/fn96-01.htm
“Recommendation: Circumcision of newborns should not be routinely performed.”
http://www.caringforkids.cps.ca/pregnancy&babies/circumcision.htm
“Circumcision is a ‘non-therapeutic’ procedure, which means it is not medically necessary.”
“After reviewing the scientific evidence for and against circumcision, the CPS does not recommend routine circumcision for newborn boys. Many paediatricians no longer perform circumcisions.”
Royal Australasian College of Physicians
http://www.racp.edu.au/index.cfm?objectid=65118B16-F145-8B74-236C86100E4E3E8E
“In the absence of evidence of risk of substantial harm, informed parental choice should be respected. Informed parental consent should include the possibility that the ethical principle of autonomy may be better fulfilled by deferring the circumcision to adolescence with the young man consenting on his own behalf.”
(almost all the men responsible for this statement will be circumcised themselves, as the male circumcision rate in Australia in 1950 was about 90%. “Routine” circumcision is now *banned* in public hospitals in Australia.)
British Medical Association
http://www.bma.org.uk/ethics/consent_and_capacity/malecircumcision2006.jsp#Circumcisionformedicalpurposes
“to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate.”
The Royal Dutch Medical Association
http://knmg.artsennet.nl/Diensten/knmgpublicaties/KNMGpublicatie/Nontherapeutic-circumcision-of-male-minors-2010.htm
“The official viewpoint of KNMG and other related medical/scientific organisations is that non-therapeutic circumcision of male minors is a violation of children’s rights to autonomy and physical integrity. Contrary to popular belief, circumcision can cause complications – bleeding, infection, urethral stricture and panic attacks are particularly common. KNMG is therefore urging a strong policy of deterrence. KNMG is calling upon doctors to actively and insistently inform parents who are considering the procedure of the absence of medical benefits and the danger of complications.”
Drops in male circumcision since 1950:
USA: from 90% to 55%
Canada: from 48% to 17%
UK: from 35% to about 5% (about 1-2% among non-Muslims)
Australia: 90% to 12.4% (“routine” circumcision has recently been *banned* in public hospitals in all states)
New Zealand: 95% to below 3% (mostly Samoans and Tongans)
South America and Europe: never above 5%
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Circumcisions are often handed over to interns (/residents/house-surgeons) for practice. Even when they are done by “trained surgeons” there may be issues. There is no dotted line, no “official” way of doing a “correct” circumcision. A baby’s penis is tiny and any mistake is magnified when he grows up. (You can see some outcomes here: http://www.circumstitions.com/Botched.html – probably all done by “trained surgeons”) It is a matter of the doctor’s whim and skill whether the frenulum is removed – the strand under the glans (the last remnant of the highly innervated ridged band that runs round inside the tip of the foreskin) that circumcised men call “the male G-spot”.
And how rare are the issues, really? Circumcision is supposed to make a boy “low-maintenance” and so parents don’t look, and wouldn’t know what to look for, and problems may not manifest themselves until adulthood. A Richmond VA pediatrician had to repair 1600 in three years, suggesting (from the local birth and circumcision rates) a complication rate of more than 13%.
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Perhaps the issue of female circumcision would be resolved if performed by trained obgyns then?
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“Its pretty obvious that by 18 years old, very few boys are going to choose to have their foreskins removed. Their frame of reference has already been set, and they are fine with who they are.”
I think this, ultimately, is the point. If we start arguing that it’s fine to force a procedure upon patients who cannot consent, on the basis that once they can consent they will not want to, then what are we really saying about autonomy? Or cultural cosmetic surgery? Or fundamental human rights? Are we really to say that infants who cannot consent should be treated as though they already have, regardless of the potential consequences or the elimination of their ability to choose when they are mature enough to do so? These implications, despite your blasé admonishment to “grow up,” are not minor. They speak to a very fundamental opinion of the humanity and personhood of brand-new human beings.
I grew up in a heavily Jewish area; I’ve known many young adult men who were circumcised at their bar mitzfa, rather than in infancy. I’ve also known Jewish converts who have been circumcised in adulthood, usually for marriage to a Jewess. If it’s culturally important to the individual, he can make that choice and often will.
As for the science, those of us who choose not to circumcise don’t “ignore” the data; we merely recognize that a risk-benefits analysis is about more than the threat posed by not circumcising. Many individuals, physicians included, behave as though risk and threat are the same, but they’re not. Threat is what may happen; risk is the probability that it WILL happen. We simply believe that the statistically negligible threat of penile cancer or UTIs does not outweigh the ethical *and* medical repercussions of RIC. Looking at the data, I don’t believe that’s an unreasonable conclusion to draw.
While we’re on the topic of risk and threat, I think that an important question for every parent of a boy is for them to ask themselves, “If my son is that rare child who has a complication, will I be able to justify my actions to him?” I believe I will be able to argue my case if my son becomes one of the rare men to have a complication from being uncircumcised, and would support him in having the procedure done on his terms. I do not believe I could do the same if he’s one of the very rare men who have a complication from being circumcised. I once babysat for a toddler whose entire penis was amputated due to an infection following RIC; no matter how rare and improbable such a complication is, even if it be only one in a million, if that one is MY child, I could never justify it to him. I don’t think that’s an unreasonable position, regardless of the statistics.
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Thanks for the comment. I also appreciate your comment about ‘threat’ versus ‘risk’, but think you are actually using the terms incorrectly. ‘risk’ is the actual likelihood of an event happening, while ‘threat’ is the perception of that risk. The former is mathematically definable idea, while the latter is different for each person, based on the emotional impact of their perception of the risk. “threat is what may happen” doesn’t capture that meaning for me.
If one chooses to circumcise because of the potential medical benefits, it is ‘threat’ that is motivating that decision. That is, the fear that failure to circumcise will lead to an untoward outcome.
Ultimately, I think this is rare, and that the decision to circumcise is almost always a decision based on culture and custom.
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As a military briefer, I suppose I should have qualified I meant “threat” in a more absolute way than an abstract one. Either way, I do think that fear is a large motivating factor for parents to circ, but it’s largely the fear that Jr will be “different” rather than that he’ll be physically at risk of disease.
When I had my first son, at every shift change there was a new doctor or nurse asking if I planed to circ. It was never until after I declined that each one of them said that there was no medical reason to circumcise. I wonder if they inform parents who answer in the affirmative of the same.
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I’m going to have to disagree with you on this one too, Dr. F. I don’t usually consider anecdotes to be all that useful, but I think this one is a good answer to your points about circumcised men being somehow tricked into being upset by intactivists.
My ex husband was circumcised at birth, but, for some reason, had no idea. When he first saw my then four year old son’s intact penis, like you, he was surprised and horrified at its appearance. He, however, mistakenly thought my son’s penis had been surgically altered or circumcised, and was very upset at me for subjecting him to this supposed mutilation. It took a lot of explaining, including a phone call to his mother, for this 35 year old man to figure out that he had been circumcised as a child. He was VERY upset when he found out, and it wasn’t because of bullying by intactivists. I am strongly against any mutilation of anyone, but I assure you I didn’t bully him into thinking something was wrong with his penis, and neither did anyone else. My opposition to circumcision does not include any discussion or judgment of people who have already had it done, just opposition to perpetuating it for nonmedical reasons. I accept that it is incredibly common, and tried to gently explain to him that he was circumcised, and so were most men in the US, including my brothers. He was, in my opinion very reasonably, upset that he had a piece of his genitalia removed as a child. He came up with his horror before I could even explain to him that my son was intact and that he himself, actually, was circumcised.
Both of my sons were also horrified when I explained the procedure to them, each at an age appropriate time. I explained it scientifically and did not say that it was horrible, unethical, painful, mutilation, or any other choice terms that are arguably biased. Both of them were horrified, also. And, I don’t think it’s just because they are somehow used to being one way versus another way. Yes, they haven’t been culturally conditioned to think it is normal because, at least in our little microcosm, it wasn’t expected. But, they were both horrified at the thought of cutting off a piece of anyone’s genitalia.
One more anecdote about intactivists being bullies, or not. I also am not fond of being labeled an activist on certain topics. I didn’t circumcise either of my boys. Both of my sister in laws did. I never, ever thought it would be appropriate to give them input on this decision, although both of them knew my sons were intact, and both felt the need to pointedly, almost defensively let me know, specifically, that they were circumcising their boys. I took the information gracefully, even if I was a little confused about the necessity of them even letting me know. I never called anyone in my family to tell them about my decision. However, my second husband’s parents found out I wasn’t planning on circumcising our son, my second son, and I got incessant bullying phone calls and in person conversations on the topic for several months after his birth. Sadly but somewhat humorously in a dark way, the phone calls stopped when they asked their good friend and handyman, who was the father of five boys, if he could believe what their ridiculous daughter in law was doing (or not doing), and he informed them that his oldest son was severely injured by his circumcision and that there was no way in hell he would subject his other four sons to it.
Being someone of the “natural” persuasion, I bristle at the frequent stereotype that we are uniquely bullies about our positions, and the more culturally common, less “natural” types are not. There are jerks and bullies on both sides.
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I had a similar experience with family, friends — even coworkers. I tried to explain my reasoning, but ultimately it came down to the fact that people are afraid of differences. Even though my sons’ peers will be at least half intact, since MY peers are not, they can’t comprehend that my boys will not be abnormal as they age. And that without violating their autonomy.
It’s also a bit disingenuous to make the assumption that circumcision doesn’t go wrong if the surgeon is skilled and it’s done properly. Without knowing how the boy will grow or what his final penile length will be, don’t most common complications arise long after “proper” healing, often well into puberty — long after the performing physician (most often the OB) or even the pediatrician has stopped caring for the patient? It seems a bit self-delusional to say that complications only happen to “someone else’s” patients.
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The anti-circ people are not necessarily bullies, but they are far more vocal that those that support or are indifferent. This is not uncommon, though, with any group that wants a change from the status quo. Those that support the status quo generally are not as motivated to talk about why things should stay the same than those that want change.
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Circumcision is a major alteration of most sexual part of the male body, the part that is inserted into the vagina during intercourse: the tip of the penis. It is presumptuous in the extreme to argue that that part of the body can be surgically altered without any effect on sexual pleasure and functionality. Hence the foreskin and frenulum should enjoy the benefit of the doubt. And from that follows the ethical rule that circumcision should not be performed until after the 21st birthday, with the informed consent of the person to whom the foreskin is attached.
Many women have been with both kinds, and have blogged that they prefer the intact number.
“Being circumcised was their frame of reference; it was their ‘normal’. The only way they could ever ‘miss’ their foreskin would be through some outside influence that convinced them of some new ‘normal’, and that they were somehow incomplete. Some of these men express anger at their parents or doctors for circumcising them as an infant, it seems to me that this anger is misplaced. It would make far more sense for them to be angry at the person who felt the need to drive a message into one’s head they were somehow incomplete, a message without which the feeling of loss never could have occurred.”
People, that is exactly the way kings and lords reacted to the growing demands in the 18th and 19th century for democracy and equality. “Without propaganda from parties contemptuous of tradition and the natural order of society, there would be no complaints.”
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I appreciate your comment, and do see your point. I think my underlying reasoning is based on my own experiences, both personally and coming from a culture where male circumcision is quite common and accepted. And like you all, I do have a right to have my own opinion.
I do think there is a very reasonable argument against circumcision, and that it is logically correct. There is also a cultural argument that explains it existence that is not logical. This cultural practice shows 21st century humanity to be similar to humanity for all recorded time. The current movement away from male circumcision may in fact catch on further, and if so it will be part of the evolution of our culture. It will be interesting to see which way it goes.
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Being part of the group that “wants a change from status quo” I wanted to give a person example. I personally was raised in a culture where circumcision was not common. I heard about it, just as I heard about it when I moved to the U.S. I was astonished when during my pregnancy it became apparent that there was that there was that big thing for other pregnant women – a questions of whether to circumcise or not. And of course, the question was always “in the air” – whether in conversations with health care provider or during chats with moms-to-be. I knew I had no plans of doing that but I was really surprised that in U.S., where majority was not Jewish, circumcision was at the top of the “agenda” of a pregnant woman. At that time I could not understand why would someone want to subject a tiny baby to an unnecessary surgery but my knowledge about how circumcision was actually performed was almost non existent.
It was not until I read an article and than saw one blog post that I got more interested in that issue. It was only after I researched the topic that I could definitively say I was strongly against circumcisions of infants.
The reason for sharing that is that I would suspect that another reason or part of the reason for the “against” group being “more vocal” is that those people learned more about it and once they did, they became outraged by what is happening in the society.
Even if I forget about studies, negative effects, and questionable “benefits” of circumcision I honestly cannot comprehend how could be that in the U.S. – the country that stands for democracy, freedom, and equality, boys and girls are treated differently, the constitutional rights are neglected, the judicial branch does nothing, and very few seem to care. If we were developing country in Africa, perhaps… but I cannot understand how this can be happening here.
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One way it could end a lot quicker is if doctors, – such as ob/gyns – would refuse to do it. They are under no compulsion, nor any obligation.
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Dr. Nicholas, do you recognize the illogic of supporting and promoting abortion (typically done by such phrases as “her body, her choice”), while also supporting and promoting routine infant circumcision (“HIS body, HER choice”)? While I most profoundly and wholeheartedly disagree with you on abortion, I hope that you can take your support of bodily autonomy and “the right to do with my body what I want”, and transfer that to support of bodily autonomy for the infant male, and to preventing others from doing with his body whatever they want.
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Maybe that’s why I can’t agree with his position. He believes the infant is the property of his mother, to be disposed of as she sees fit before “personhood,” and (ostensibly) be dealt with as she sees fit after birth. I see the infant as his own property from the moment he comes into existence, to be respected, honored and protected until he can steward his own life.
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Regardless of views on abortion I think it is somewhat discriminatory to point fingers at mothers for circumcising their children. Unlike pregnancy, here there are usually two parents involved, and in many cases it is actually the fathers who want their sons to look like them and be circumcised.
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Ekaterina, this may be true (it was in my case — my husband strongly desired to have our sons circumcised as he was), yet it is my understanding that it is the mother who must usually give consent. At least at birth, in the hospital (which is when most circumcisions take place — prior to hospital discharge a day or two later), the mother is known to be the child’s parent whereas the man may not actually be the father, so if there is a difference of opinion, it is the mother’s wishes that are followed. Also, if circumcision doesn’t happen at the hospital, it is usually the mother who makes the appointment and takes the child to the doctor for circumcision. Sure, sometimes the fathers force the issue, force the mother to allow her son to be circumcised, or take the child to the doctor alone to be circumcised; sometimes both parents are in total agreement for or against circumcision; and sometimes the mother wants the child circumcised over the father’s objections.
So while you’re right that fathers share some share of the decision-making process and therefore the blame, most of the time it is ultimately the mother who goes forward with the process, so it is not truly discriminatory to place most of the emphasis on the mother, though it is perhaps a little exaggerated. Still, the ultimate point remains the same — for someone who supports abortion due to “bodily autonomy” or “my body, my choice” is hypocritical for supporting, performing, or advocating for routine infant circumcision, because it certainly violates the baby’s bodily autonomy, and “my body, my choice”.
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I have greatly appreciated your blog in the past. Unfortunately I don’t have the time to read all the responses, but I had to chime in and say I think you’ve got it all wrong here. Sure, you’ve turned out alright and so have millions of circumcised men, but that’s no excuse for continuing a practice that has very little medical benefit (especially when that benefit could be achieved with education instead of surgery) and has such complications as interfering with breastfeeding, infection, and possible imminent death (admittedly rare). I don’t believe we should sacrifice evidence-based medicine to bow to cultural concerns in this case.
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Here’s my opinions for what they are worth. I have four sons that I chose not to circumcise for many of the reasons already mentioned. In nursing school, I remember watching a circumcision that made me realize I would never want to do that to my son with little reasons to do it. I also think most parents are not educated in this matter and have no clue about the medical issues involved and I’m always a little disturbed talking to people who choose to have their sons circumcised without knowing what it is they are doing. So, I do try and educate people. That said, I also feel like parents should have the right to decide this. Parents make lots of decisions for their children that can have a major impact on their children in the future. One friend of mine choose to have a major surgery on her child that she thought would help, but has instead stunted the growth of her child’s leg. This obviously was not her intention. We are all usually trying to do the best we can for our children, though. I think what we need is less hatred towards each other and more education.
On a side note, for those attacking Dr. Fogolson and saying he should not have an opinion about this because he is an ob, seems odd to me. Any and all people have the right to have an opinion.
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Hi Dr. Fogolson,
Just a couple quick comments I hope you will consider from a fellow medical professional. The last few minutes of your grand rounds presentation on delayed cord clamping from 1/30/2011 is very applicable to the circumcision debate. Specifically, as with any intervention in medicine, the burden of evidence should be on the one promoting the intervention to prove that it is safe and beneficial.
Also, I’ve read you comment a couple times that this practice stemmed from a religious mandate. This is not really true. A few quick reads on the history of circumcision in the United States and ancient Jewish circumcision (I am unsure about the Muslim tradition) will show that the current modern circumcision is not at all the same as the procedure which was performed in the Old Testament, and that it was promoted by Dr. Kellogg (yes, inventor of corn flakes) to reduce sexual pleasure to curb masturbation. Those are the roots of this social custom, in addition to beliefs that circumcision could cure bedwetting, insanity, hernias, diarrhea, and epilepsy (an interesting read from our own medical journals: http://www.noharmm.org/docswords.htm). Circumcision was banned in early Christianity, and the New Testament is clear that Christians are actually called to leave their sons as they were made.
Consider also that the oath you swore was to first, do no harm, and that this surgical procedure does, in fact, injure the penis for everyone but the patient it’s performed on. For a social custom?
I’ve performed a circumcision and I deeply regret it. I had no idea what I was doing. The only thing I was taught was how to cut a foreskin off.
Now, as a mother of an intact son, I am frustrated by the lack of knowledge of my fellow medical professionals on the normal physiology of the penis and proper intact care. I have to care about this because it is clear that physicians are turning the other way on this issue instead of talking about it. The babies are speaking as loudly as they can with their screams. Someone has to care about this or it will never change.
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Oh, Dr. Nick. You’re breaking my heart!
A few issues:
1) The evidence that circumcision decreases sexual pleasure is found in the fact that was PRESCRIBED for this purpose, originally. Good ol’ Dr. Kellogg even hoped that the boys would remember, to be extra hesitant to masturbate. Also — a little selfish, huh? What about the ladies? Many women report enjoying intact sex more.
2) You’re an OB (for crying out loud). You’ve just lost any credibility in excusing defensive medicine if you think the risks from elective cosmetic neonatal surgery are completely justified … for parental preference? Wow.
3) You better be willing to do diapering for your hypothetical circumcised newborn. He’ll need wound care … in a diaper. Good luck. That is, of course, if your wife actually caves to your entire lack of reasoning and doesn’t protect her baby from cosmetic surgery like she probably will.
Cheers, Dr. Nick!
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Cheers to you as well! We can’t all agree on everything. There’s a good rational argument against circumcision, just as there is a irrational argument in favor of it as a cultural tradition.
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“We do what we can with what we know at the time. When we know better, we do better.” If cultural traditions are based on a lack of information, they should be discarded when more reliable information comes to light.
Also, I’ve often wondered about wound care for infants, whose immune systems are so susceptible to infection. The one botched circumcision I’ve seen was performed perfectly, but the baby contracted MRSA resulting in significant tissue amputation. I’ve heard people warning me of everything from phimosis to balanitis, but an open wound in a disease-ridden hospital, left to heal in a dark, warm, urine- and poop-filled diaper, well, that’s no big deal?
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Dr. Nick — you respond, honestly. as I would expect any circ’ed, American, childless man would respond. I have hope that with deeper research, you will display again your extraordinary ability to overcome bone-deep biases. (any puns in this post are entirely unintentional)
However, I would point out that you are no longer in the majority. The ‘status quo’ is intact — 68% of newborn males in 2009. You would be condemning your son to be the minority.
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Sadly, the rate of newborn circumcision in the US still seems to be around 55%, though it is declining very slowly:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6034a4.htm?s_cid=mm6034a4_w
The figure of 32% comes from a paper by CDC researcher Charbel El Bcheraoui
http://pag.aids2010.org/Abstracts.aspx?AID=4529
I was there when it was presented at the AIDS conference in Rome.
It’s not clear why the figures are so low, though there seems to have been some major sample bias. Since Dr. El Bcheraoui was trying to argue that steps should be taken to reverse the decline, there may be some researcher bias too. It always seemed unlikely that the rate would vary by more than 1 or 2% a year.
It’s worth noting that when the circumcision rates in Australia and New Zealand dropped below 50%, those in favor of circumcision immediately seemed to forget the “locker-room argument” where they used to tell people that they shouldn’t want their sons to be the odd ones out.
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I also think that the quoted rate of 32% is artificially low. From what I’ve read, the researchers arrived at the rate of 32% by looking at billing for circs that happened in the hospital and/or were paid for by insurance at a doctor’s office. Since Medicaid doesn’t pay for RIC in many states (calling it a “cosmetic procedure”, NOT a “procedure with slight medical benefits”), insurance companies in those states have likely followed suit. If the circ wasn’t billed to Medicaid or insurance, it wouldn’t have shown up in the study, even if it was performed. The circ of at least one or two of my nephews wasn’t paid for by the insurance company (my sister lives in one of those states where Medicaid, thankfully, doesn’t reimburse, and while they had insurance, the ins co. didn’t cover it either), but they still had it done, paying cash for it — and ended up paying the same out-of-pocket as they would have paid for copay (and perhaps deductible), had the insurance company covered it. The circ certainly happened, but it wouldn’t have been included in that study, since it was not paid for by the insurance, nor did it happen in the hospital.
I’ve also been reading about a lot of circumcisions that happen not just out-of-hospital, but two weeks or more after birth — sometimes when the baby is a month, or even several months old. I wonder if these would be included in that study, or if they would be limiting the billing time frame to just the neonatal age. That also might skew the results.
However, some parents may decide not to have it done once they are told, “Medicaid/insurance doesn’t cover circumcision because it’s considered a cosmetic procedure, and no medical organization considers it beneficial or necessary.” Many people do more research when it comes to buying a crib, layette set, stroller, or car seat, than they do the medical procedures surrounding birth, and consent to their son’s circumcision simply because they assume that *if* it is done or offered, there *must* be a benefit for it, or because that is what everybody else they know did/does/has done, so think it is necessary or beneficial. Some of these people say that they wish *somebody* had told them that it was just cosmetic, and that if they had known that at the time, they would never have amputated their child’s foreskin. So, I do think that the rates are dropping a bit more than 1-2% per year, simply because there are people who choose to leave their sons intact, once they find out it is not a covered procedure, and/or is not medically necessary. As more and more babies are left intact, more women will see these intact babies, and will start questioning the circumcision norm we grew up with. [I saw my first intact baby/male when I was about 15, read the first “question circumcision” article when I was about 20, and came to view it as an unnecessary procedure from that. Had I not, I would likely have handed my babies over to be cut without much thought, since almost every boy I had ever known, and every boy whose diaper I ever changed, was cut.]
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Dr Fogeldon,
Imagine for a moment the removal of one testicle from infant males was a long-standing cultural practice with religious significance which was given medical legitimacy in terms of improved health (reduced risk of testicular cancer) with reproductive function mostly preserved.
Would you indulge a parental request to perform this procedure on a child?
Why or why not?
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“Monorchy” or the ritual removal of one testicle used to be a real cultural rite, and has been reported in Africa and the Pacific Caroline islands.
http://books.google.co.uk/books?id=BwQT9fdZNdgC&pg=PA183&lpg=PA183&dq=testicle+removal+tribe&source=bl&ots=9DsuYh7wGg&sig=mkefC0dVsFn1FvwNlmcfSM8Ewlk&hl=en&ei=Wo3dTtXHOYvFswbdtYnkCA&sa=X&oi=book_result&ct=result&resnum=8&ved=0CFcQ6AEwBw#v=onepage&q&f=false
Regardless of why it began, you can see how difficult it would be for such a rite to die out, since those who had undergone it would do everything they could to make sure everyone else had to undergo it, including extolling the health benefits and pointing out how much more attractive it made those who had undergone it. All other forms of genital cutting, both male and female are similarly promoted by those who have undergone them.
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Ok, last one — just think about this…
“You want a homebirth? Selfish!”
“You want a VBAC? Selfish!”
“You want intermittent monitoring? Selfish!
“You don’t want to supplement with formula? Selfish!
“You want a circumcision? Sign here.”
and I know that you aren’t one of the OBs going around calling mothers selfish for their choices. But you can’t shrug off your profession that easily here. We are constantly urged to take unnecessary precautionary measures, often at our own discomfort or the risk of our own health — for the safety and health of our baby.
How small do the risks from circumcision need to be for this to NOT be a glaring hypocrisy?
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A doctor’s duty is to medicine, not “cultural tradition.”
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Certainly when you graduate medical school you will be able to execute your duty as you see it.
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Only with the respect to the still-developing sexual organs of male children can a doctor act as he or she sees fit.
In all other cases involving children, there are legal frameworks and principles of ethical medical practice to guide – and curtail – the physicians actions.
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My wife is pregnant and I’m struggling to decide whether I should have my son circumcised or not. I’m not circumcised, and very few of my countrymen are either. It sounds that the pros are slightly smaller chance of contracting STDs and making him feel comfortable in the locker room (given that he will be born and raised in the US, where the majority is) and the cons are small chances of surgery complications. Thoughts?
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Your son would not be in the majority any more, if circumcised. Not for the entire US. There are some states where the rates are still higher, but they are dropping every year. And if he moves?
You missed the big con — that’s its an entirely elective cosmetic surgery. The hospital is going to bend over backward to protect your baby during labor and birth, do whatever they think necessary to hand you a whole, perfect child, even measures that put your wife’s health at (slight) risk instead. If she wants to breastfeed, they may push supplementing with formula ‘just in case’ baby gets a bit dehydrated. But if you *want* to surgically alter your healthy newborn? Sure — they have no problem with that.
Let him decide, when he’s older. He’s at no risk of STD now, right? Serious complications from newborn circumcision might be rare, but they are 100% preventable. There is ZERO risk from not circumcising.
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Condoms are more effective at preventing STDs than circumcision, in even the most generous estimates from the most biased studies in favor of circ. Japan, for instance, has extremely low rates of HIV/AIDS and also extremely low rates of circumcision; whereas America has high rates of HIV/AIDS, and very high rates of a variety of STDs, though most adult males are circumcised. Abstinence, of course, is by far the best method of preventing STDs, and unlike circumcision, there are no adverse health effects [though some men may think that doing without sex will kill them ;-)].
As Jamie also pointed out, the trend in circumcision is a decreasing one; so while most American men are circumcised, every year more boys are left intact than the year before, and I’ve seen official rates as low as 30% (though I think they’re missing many circs in those counts), so if you cut your son just so that he will be in the majority, he may be one of the minority when he is actually old enough to know or care.
Think to yourself, what if something unintentional happens with your son’s circumcision — what if he is one of the few who has a heart attack due to the stress, or loses too much blood, or gets MRSA or some other major infection from the open wound? or something not deadly or life-threatening, but is one of the ones who gets adhesions and has to have another surgery (or multiple surgeries) to fix the problem, or too much skin is removed, or his penis is disfigured, or even the glans of his penis is amputated? what if, when he gets older, there isn’t enough skin to allow for a full erection, and sex is painful or impossible? Would you think it sufficient to say you chose to circumcise him and put him through all that because you were worried he might be teased in the locker room?
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I think its a cultural decision above all else. Many passionate people have commented here and no doubt will try their best to talk you out of it.
There are marginal medical benefits, and potential risks and potential effects on sexual function which in my opinion are also marginal.
I’d just do what feels right to you.
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What are medical practitioners doing carrying out cultural rituals, instead of sticking to medicine?
Is a doctor’s duty to medicine, or religious, cultural, societal etc. mutilations?
If doctors have an obligation to culture etc., then obgyns would be well justified to perform “ritual nicks” as the AAP tried to justify also.
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“If 50 000 people do a stupid thing it is still a stupid thing”
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Umm…his son will have a Jewish father and possibly a Jewish mother. If avoiding being part of a minority was of value, unfortunately, that ship has sailed.
There are significant numbers of circumcised and non-circumcised males in the US. Clearly, both choices are working out ok.
The only real minority here are the tiny percentage of “intactivists” as compared to adults with a sense of perspective.
I’m curious how many of the comenters here who mentioned fgm who have done anything to end that practice. Anything at all. Even posting on a message board.
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There are probably a lot more intactivists than you think, and almost certainly a lot more men who aren’t happy about being circumcised, or who have problems that they don’t even realize are connected to circumcision.
The battle over female cutting has pretty much been won, at least in the west. I’m a member of an organization whose primary focus is the ending of FGC though, and have posted several times on message boards about the issue. Pretty much every time someone blogs to say they’ve had their daughter cut, or they’re thinking about it, I’ll be there. I’ve also spoken with the police here in the UK about why no-one has ever been prosecuted for FGC (it sounds like they want that just as much as I do btw).
Everyone, male, female, or intersex, should have the right to determine what if any genital surgery they undergo.
I think it’s a cheap shot to suggest that intactivists don’t have a sense of perspective. Do you make the same accusation towards people who focus mainly on female cutting? The people who defend it routinely suggest that anyone who’s against it should have better things to worry about than what they’re doing with their daughters.
Is it just a minor issue that people are trying to raise two bilion dollars to circumcise 38 million men in Africa, when the likely result is that AIDS infections will increase rather than decrease?
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If you call something a cheep shot, you have to explain why. To the overwhelming majority of human beings, this is not an issue worth activism. The only people who care are either “intactivists” or those who circumcise for religious reasons and live in areas where that right is threatened legally.
(I’m breaking my rule about not writing on the internet anything you wouldn’t want to say in front of your child’s class at school. Apologies all around…)
Here’s a thought experiment: suppose circumcised men were able to choose between a small increase in penis size and having an uncircumcised penis. I feel pretty confident that almost all men would choose the size increase.
I wouldn’t think that even after all of the intense emotional abuse involved in explaining to a circumcised person how harmed they are, the vast majority would go for the size increase.
I think a man would have to be primed in some way to believe 1% of the intactivist claims from the websites linked above. They don’t follow human physiology, statistics, or basic logic. There has to more going on than just normal human insecurity to get behind this.
I think the downsides involved in a father telling the world how bad his sex life is compared to his imagined situation with his foreskin, the intactivist t-shirts (!), the tearful mommy blogs bemoaning your first son’s stunted future as compared to a second son who thankfully escaped that fate and will have a much better life (note to parent: the circumcision or lack thereof is not what is messing up your kids)– it really does speak to a lack of perspective.
Would anyone put their child in a tshirt
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I would take maybe a 25% reduction in penis size rather than be circumcised, and I think most intact men would take at least a 5% reduction. There are also some very unhappy circumcised men who would gladly take a reduction just to be intact.
The websites I’ve linked to include the CDC, BMA, CPS, RACP and KNMG, and the only other link I’ve put in is to an inactivist pages which lists quotes from medical journals explaining the rise in male circumcision in the late 19th and early 20th centuries (hmm, one of those comments doesn’t seem to have been approved yet). If you think that 99% of the claims on the intactivist sites are bogus, then I can’t help thinking you’re the one who isn’t following human physiology, statistics, or basic logic. If you’re circumcised yourself and most men in your area are also circumcised, then you may be starting off from the viewpoint that it can’t possibly be a big deal, but remember that women feel the same way in countries where female cutting is common.
Australia used to have a 90% male circumcision rate, but “routine” circumcision is now *banned* in public hospitals. Doesn’t that tell you that maybe those wacky intactivists aren’t quite as crazy as you’d like to believe?
I asked you already if you would accuse people who focus mainly on female cutting of a lack of perspective. Do you think a woman would “have to be primed in some way to believe 1% of the intactivist claims” from anti-FGC websites?
If you’re circumcised and happy, that’s great. I honestly think though that the more you find out about circumcision, the more you will question it. Either way, I think your children and everyone else’s should be able to decide for themselves whether or not they have parts cut off their genitals. It’s *their* body.
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“…suppose circumcised men were able to choose between a small increase in penis size and having an uncircumcised penis. I feel pretty confident that almost all men would choose the size increase. ”
Now suppose that intact men had both their foreskin *and* a small increase in penis size (3/8″ or 8mm), as this doctor has found. Interesting….
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I hit post too soon, or maybe not soon enough.
The fgm comparison breaks down in lots of places– but just polling fgm victims about what one body area they would magically change would likely result in very different results than the same question posed to men circumcised as newborns.
So, I would ask any serious intactivist why they are not involved in helping children who suffer from ongoing pain from poverty or neglect or illness. I can’t fathom being so concerned about theoretical future babies’ potential pain and potential imagined PTSD. I’m sure that the children in your area could really benefit from your volunteering at a public library or helping with homework over the phone. I think it’s a really positive impulse that just took a wrong turn.
So, in long-winded conclusion, I don’t care who circs as long as it’s legal 🙂
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I think the comparison with FGC is striking, and it certainly wouldn’t break if you polled victims about which parts of their body they’d change. I think the majority of women as well as men would not choose to undo the cutting, even in western Africa where the most extreme forms are practiced. That doesn’t make FGC ok though. FGC is legal in many countries btw, and was so in the USA till 1997, so up until then you’d presumably have said you didn’t care about it. It’s interesting how you talk about “fgm victims” but would never regard circumcised men the same way. Most women who’ve undergone FGC don’t regard themselves as victims either, and they get furious if you call it “mutilation”.
You’re right that there are other things I could be doing with my time, but you could tell anyone who’s an activist about anything (including FGC) that maybe they should be doing volunteer work instead. I know you disagree, but I happen to think that male genital cutting is important, especially now it’s being promoted in Africa, when it seems likely to result in even more deaths from AIDS. I also believe that circumcision is something where I’m more likely to change people’s views than most other issues.
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Dr. Fogelson,
I have read your recent post on delayed cord clamping and thoughts on internet expertise. I watched your grand rounds speech in the past and that new post prompted me to look for your older post on delayed cord clamping, which I have just read. After reading it, especially the “introduction” part of it I can not really find it difficult to comprehend how you can still continue to support practice of circumcision, as the later one is established to not be recommended by any medical recommendation and to be purely cultural, and have potential (however small you believe it to be) for side effects: your statements about shifts in thoughts in medical practice, episiotomies, about your willingness to research the topic, you having “to think about evolution and function”; that “does this mean that early cord clamping is necessarily harmful? Absolutely not. But what it means is that the burden of proof is on us to prove that early cord clamping,”; that “even under creationist thinking I have to believe that if the system meant for babies to have been phlebotomized of 50-100 cc of blood at birth, we would have been born with higher hemoglobins. Clearly the natural way of things is for this not to happen.”; “I wonder at times why delayed cord clamping has not become the standard already; why by and large we have not heeded the literature. It is sad to say that I believe it is because the champions of this practice have not been doctors, but midwives, and sometimes we are influenced by prejudice. Clearly, midwives and doctors tend to have some different ideas about how labor should be managed, but in the end data is data. We championed evidence based medicine, but tend to ignore evidence when it comes from the wrong source, which is unfair. It is fair to critique the research and the methods used to write it, but it shouldn’t matter who the author is. In this case, Mercer and other midwives have done the world a favor by scientifically addressing this issue, and their data deserves serious consideration”; statements “this is a part of our culture that should change. This evidence is compelling enough that I feel like a real effort should be made in this regard”.
I do not meant to purposefully make more out of what you intended to say. The way I read that post makes it appear that after some time you were open to different opinions on what you had being practicing, and you did more research yourself, and you confirmed that the burden of proof was on those “altering” the nature’s way. I understand that circumcision and delayed cord clamping are different things that you may believe the research for the “benefits” of not circumcising is not as apparent. Still the benefits of circumcising an Infant, are any benefits present for an infant? Why was it ok to change the cultural norm for delayed cord clamping and episiotomy but not OK for Infant circumcision?
Respectfully,
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I think you make a great point. We have two different cultural practices, and two different arguments on why we shouldn’t do them. I think you can fairly argue in the same way that we shouldn’t circumcise male infants.
These cultural practices, however, have very different origins. Immediate cord clamping came as a byproduct of pediatric resucitation and birth practice changes. It was a thoughtless change. Male circumcision originates in a thousdands of years old religious tradition, with quite clear origins in the Old Testament. I’m not a particularly religious person, and don’t see that origin as being inviolate, but I do recognize that because of this origin male circumcision has a lot more cultural traction than immediate cord clamping.
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Let’s see; doctors using their tools and training to inflict non-therapeutic circumcision surgery is somehow made acceptable because of it’s long history and religious significance.
To many of us, this is about as valid (and abhorrent) as a Shia Muslim doctor using his tools and training to hygienically slash a young boy’s forehead to allow sheets of blood to run over his face while witnessing self flagellating men during holy Day of Ashura celebrations. At least no healthy, functional body parts are removed as part of this traditional practice, I suppose.
Dr Nic, when you don your white coat, you should be behaving like a medical professional and acting solely in the best interests of the patent, not like a witch doctor carrying out traditional / ritualistic blood letting practices on hapless and unwilling victims. So please, check your cultural biases at the door of your practice.
I’m honestly surprised the many thoughtful and intelligent comments above have not prompted some deep reflection on the place of religion and traditional cultural practices in modern medicine on your part. Some time soon, I hope.
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I certainly appreciate that you read my response and responded to it. There has being said so much about the topic in this blog that hardly anything new can be added. The only thing is that to my knowledge majority of people in the U.S. opting for circumcision are neither jewish nor muslim, and they really do not express any religious reasons for their choice, rather the fact that everyone does it and everyone they know is circumcised, or simply that they haven’t given it a second thought (given “everyone” does it). This, I agree, is culture, but to me it appears U.S. culture of circumcision does not really have true religious roots (I personally also would not see religious roots sufficient to justify this procude). Still since majority of public tends to trust their doctors, and rarely a doctor advises against infant circumcision and almost never explains that no medical association recommends it, it seems that in a way circumcision in U.S. is a byproduct of pediatricians/medical doctors’ common (thougthtless?) practices.
And while I may not support the language choice in responses of some other people here I would agree with the following. To me it seems that being a medical doctor requires one to try to put aside own cultural biases (and this is why I compared this with cord clamping previously), to be more a medical professional rather than representative of common practices. It seems all doctors in many countires take the oath, the first and foremost part of which is “first do no harm” to the patient.
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What about just leaving the baby’s genitals alone so that in due course he can just do what feels right to him – probably nothing.
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This is just an elaborate version of “Let’s talk about something else.” Sure there are more important issues. There always are. You have your priorities and I have mine.
I don’t care who circs as long as it’s legal
That’s why part of Intactivism is about making it illegal – or as lawyer Peter Adler argues here, establishing that it is already illegal.
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Just a follow up to an discussion above: I wrote that the level of intensity in American anti-circ activism represents a profound lack of perspective. Someone mentioned that they felt that anti-circ issues were especially important given the push for circ in Africa (as a way of limiting the spread of HIV). I finally read-up on the issue. My response: SERIOUSLY?? The figure I saw was treat 7 men, prevent one case of HIV. Because nothing makes you glad that you still have your foreskin like kaposi’s sarcoma.
That thing about perspective: that’s a good example. If I had a choice between losing a hand and being HIV positive, I’d lose my hand. Hopefully, none of us (people, the world-over) will have to face that kind of decision. Still, how can someone look at the situation with HIV/AIDS in Africa, and think that voluntary circ by adult males is an issue.
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Yes, seriously. I wrote that (in comment 126), and I’ve presented way more than enough evidence to suggest that promoting male circumcision will actually result in *more* HIV infections in Africa, not fewer.
I’d rather lose a hand than be HIV+ too, but there isn’t a link between losing a hand and HIV, just as there isn’t a link between losing a foreskin and a lower risk of HIV.
At the risk of repeating myself:
From the USAID report “LEVELS AND SPREAD OF HIV SEROPREVALENCE AND ASSOCIATED FACTORS: EVIDENCE FROM NATIONAL HOUSEHOLD SURVEYS”
“There appears no clear pattern of association between male circumcision and HIV prevalence—in 8 of 18 countries with data, HIV prevalence is lower among circumcised men, while in the remaining 10 countries it is higher.”
Click to access CR22.pdf
The South African National Communication Survey on HIV/AIDS, 2009 found that 15% of adults across age groups “believe that circumcised men do not need to use condoms”.
http://www.info.gov.za/issues/hiv/survey_2009.htm
From the committee of the South African Medical Association Human Rights, Law & Ethics Committee :
“the Committee expressed serious concern that not enough scientifically-based evidence was available to confirm that circumcisions prevented HIV contraction and that the public at large was influenced by incorrect and misrepresented information. The Committee reiterated its view that it did not support circumcision to prevent HIV transmission.”
The one randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised btw:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60998-3/abstract
ABC (Abstinence, Being faithful, and especially Condoms) is the way forward. Promoting genital surgery will cost African lives, not save them.
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This is pretty interesting data. “Findings from the 18 countries with data present a mixed picture of the association between male circumcision and HIV prevalence (Table 9.3). In eight of the countries (Burkina Faso, Cambodia, Côte d’Ivoire, Ethiopia, Ghana, India, Kenya, and Uganda), HIV prevalence is higher among men who are not circumcised, although the difference between circumcised and non-circumcised men is slight, except in Kenya, where the difference is substantial (HIV prevalence of 11.5 percent for non-circumcised men compared with 3.1 percent for circumcised men) (Figure 9.1). In 10 of the countries—Cameroon, Guinea, Haiti, Lesotho, Malawi, Niger, Rwanda, Senegal, Tanzania, and Zimbabwe—HIV prevalence is higher among circumcised men.”
Given this data, I’m not sure what the real answer is. I’ve always held that when we have this type of disparity in data, it is often due to the method of data analysis in each study, or statistical variance. After all, at a fundamental level circumcision either reduces the risk of HIV transmission or it doesn’t – I wouldn’t think it would matter which country it was in. Some of the countries show a pretty strong association between circ. and lower HIV rates (Kenya most strongly), but as these data are observational there is certainly plenty of room for bias to creep in.
Thanks for the data!
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Dr. Fogelson,
I do not know much about culture and socio-economic situation and traditions in African countries. However, I would say that theoretically it could matter which country or which part of the country, and it could affect results in either direction. For example, if in particular country or region people tend to believe that circumcision protects an individual and condoms are not necessarily it could make HIV rates higher among circumcised men. On the other hand, if circumcision in a region is performed more among wealthier men, who have money to pay for it, and who are more educated – educated to know to use condoms, HIV rates could be observed to be higher among uncircumcised. I am sure there can be many more causes of similar biases. Of course, biases introduced during data collection and analysis could also be present.
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As a Breastfeeding mother, I value that my husband does not need to use my vaginal walls for friction. I anticipate less need for (potentially carcinogenic) Estradiol lubricant in Menopause. My husband is actually partially Circ’ed, but he has a 2 or 3 skin (rather than 4). There is some information that Traditional Circumcision may have been more like this, less radical. My husband still has his frenulum & rolling, gliding action & his glans is only Keratinized near the top.
If you understand the mechanics of intercourse or mastrubation with an intact penis, you will understand why women sometimes express preference. I have had a *great* time with a fully/radically Circumcised man, but ultimately, for my breastfeeding & older years, I prefer the rolling, gliding action as it is gentler.
And I can’t resist plugging the TLCTugger. I have looked @ all the devices & this is the most efficient & affordable.
Circumcision affects only female to male STD transmission, which is the least likely route. IMHO there may be considerable reporting bias overseas considering male & male intercourse.
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ETA: I believe Circ will eventually be shown to increase HIV transmission TO women (make to female) per act of intercourse, as sex w/a Circ’ed partner is generally rougher & more frictiony and I believe condom use (never popular) will be decreased as this is being marketed as a ‘60% effective vaccine’ BUT it is sort of a tree falls in the woods theoretical issue b/c if fewer men have HIV to transmit . . .
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ETA: Regarding Circ in Africa: it is only intended to be *voluntary* and *adult* for the adults that exist RIGHT now. An RIC campaign is concurrent & organized by the same folks. You must also consider RIC when discussing Africa, because that is what is actually intended & happening.
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I’m probably not going to check if anybody responds to this because it will most likely be a negative response but I paid out of pocket for my son to be circumsized because of how important it was to me that he never go though what me and several members of my family have. We have repeated UTI’s mostly the women but a few of the men too(yes I realize that it’s not usually genetic but no one has ever given us another reason). Because of them I’ve had 14 years of bedwetting,some minor kidney damage and years of intense pain starting as an infant. I would do anything to keep my son from experiencing any of that kind of pain.
I view it like immunizing him. When I immunize while he may have short term pain and complications are possible the long term benefits are far more important and will benefit him for the rest of his life. Sometimes as parents we make choices for our children that may have some pain involved because long term benefit and honestly I don’t think any of the people who describe a UTI as no big deal have ever had one as a 3 year old.
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Circumcised boys also get UTI’s. Girls get four times as many UTI’s as boys, but they don’t get treated with surgery.
I would pay a year’s salary to avoid either me or my son being circumcised.
I’ve had a UTI once (due to kidney stones) btw, and it wasn’t pleasant, but I really don’t see how being circumcised would have made any difference, and not one of the many urologists I saw ever even mentioned circumcision.
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I’ve also noticed that many (not all) anti-circ’ers tend to be rather zealous when it comes to imposing their opinions on others. I think that they are ultimately hurting their cause, as many of them resort to shouting and name-calling (in this post alone, the doctor has been called a troglodyte, charlatan, a hypocrite, etc.). Nothing screams “I don’t have a valid point but I don’t want to admit it” more than name-calling. And the thing is, the anti-circ’ers DO have a valid point, but they often present themselves as frothing-at-the-mouth extremists.
There are also groups of people who believe vaccinating their children is not a good thing to do, as it has been shown to lead to increased incidences of autism. There are other groups of people who choose to baptize their children in a certain faith to protect the child from purgatory. Other parents decide to circumcise their children because they believe in the medical and cultural benefits. With each of these groups, there is another group that disagrees. That’s fine. We are all taking in the information that is available to us and trying to choose what is best for our children. I just wish we could all be a little more tolerant about it when other parents draw different conclusions.
Personally, I admire the doctor for writing his opinion on such a hot-button issue. That’s gutsy, considering the response he knew he would receive (and ultimately got) from anti-circ’ers.
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In your write up you say:
“My biggest question in all of this is just why? Why do people care so much about this? Its really hard to say that an infant is being victimized by the procedure. Their frame of reference is being changed, no doubt, but as that frame is changed so early in their life there will be no sense of loss unless someone feels the need to convince them of it.
______________________________________-
You ask “why” people care so much about this. I find it simple to say that an infant is victimized with unbelievable cruelty by this procedure performed on a healthy infant. Maybe people are compassionate towards a newborn and believe his opinion about a life altering decision is of utmost importantance.
Let me see if I understand you correctly, so you say, the fact a newborn dosen’t remember the protective moveable cover of his genitals lopped of at birth (oftentimes awake screaming bloodymurder till he curled up and went into shock) and when his opinion meant nothing because he could not talk, that he is not a victim? You would not remember it either sir, as I see you don’t, and am highly puzzles as to why you would defend it, but you would be a victim. And if your opinion about what happens to your life and health doesn’t matter just before your are victimized, it certainly won’t be important throughout your likely life, since major perceptions and self worth are formed early by things that happen to you.
Denial of victimization isn’t likely to help people who had this done to them, but at least maybe some compassion, help and public awareness can prevent its continuance upon the innocent, whose opinions matter to me as much as the presidents. I can only imagine all we have missed due to this occurence, and I realize there is no way to compensate for the loss to these people I highly perceive to be victims.
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Self-serving rationalization.
The same applies to female circumcision.
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Dr. Fogelson,
I would first like to say that I really enjoy your posts. I am reading up on circumcision because I never really considered that it was an option and I am expecting a child. I had never experienced an uncircumcised penis until my nursing training and began to wonder why we do it? My question is that for the delayed cord clamping you gave the reason that there is a burden of proof of the intervention. Shouldn’t the same be for circumcision. Being an atheist you have no religious reasons, and as you point out the risks for foreskin cancer are low. The burden of proof should be on circumcising not abstaining from it. I have yet to take a personal stance on this position I am just gathering information to make an informed decision (which I may not have to the sex of the baby is still unknown!). My only reason for not doing it is why put a child through any amount of pain with no proof of reasonable benefit. Thanks for weighing in on topics so riddled with emotion!
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“grow up”? That is your argument, really? An essentially cosmetic surgery is being performed by physicians on babies. That is really unethical. other cosmetic procedures would not be performed by simple parental request because the risks clearly outweigh the benefits.
The core of this issue is that children aren’t things that are owned by their parents. They should not be treated as such. No baby is really jewish, their parents just brand em that way for life. Would you be ok with branding a baby with a verse from a holy book, if it were traditional in some part of the world to do so? Do you think physicians could ethically participate in such a tradition?
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Judaism is far more than a religion. It is also a bloodline and culture, with a specific genetic bloodline. One only needs to look at the concentration of genetic diseases among the Ashkenazem to know this. Jewish children are of this bloodline whether they choose to follow the religious tenets of Judaism or not, and in that way they are Jewish at birth.
As my culture finds branding of children to be abhorrent, I think it sounds like a bad thing. As your culture apparently finds circumcision to be abhorrent, you feel like it is a bad thing.
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One can be Jewish by blood but one can also become Jewish by converting to Judaism. Furthermore, one can be Jewish by blood but be an atheist or have different religious views. So to me it seems Jewish parents may “label” their children as being “Jewish” from decent. But this does not automatically mean circumcising their children is OK. Those children may indeed decide on being baptist or orthodox, for example.
Words may be interpreted differently. So the words “no baby is jewish…” could be meaning something similar to “no baby is born an orthodox, parents just label them that way”…
Still, the cultural argument for circumcision seems strange, as it has being pointed out previously it is exactly the same argument used by advocates of Female Genital Cutting, which is a crime in the U.S., in the U.S. – the one Nation… with liberty and justice for ALL.
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A Jew choosing to become Baptist? Oi vey! Never seen it.
There is a big difference between being born Christian and being born Jewish. One is a religion that is shared by people of all different ethnic backgrounds. Being Jewish is an ethnic background in itself, as well as being a religion.
Conversion to Judaism is possible, but not nearly as common as it is in Christianity. Prosyletization is not part of Judaism. Jews do not try to create other Jews, other than by having Jewish children. Conversion is generally discouraged, though allowed when someone shows true commitment and interest, including willingness to pursue a significant amount of study and learning. In many cases non-circumcised males who convert choose to become circumcised as well. Imagine that.
As for Jewish atheists – yes there are a lot.
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I agree, very few people chose to convert to Judaism, and it is not an easy prosses. One has to devote significant amount time to it. I think people of Jewish origin who chose to become christian may not be as open/public about, they probably would not be “advertising” their Jewish background or their religious views either. It is one thing to say you are Jewish but do not go to Synagogue, and something very different to say you are Jewish but go to Church… Still, I do know one person who is christian and has Jewish roots… And many many Jewish people, especially non religious Jewish people, are not circumcised. Being born Jewish does not automatically make or require one to be religious. And … you said yourself that there are many Jewish people who are atheist, so… aren’t Jewish parents who are circumcising their sons indeed labeling them? … those sons might choose to become atheist when they grow up but they won’t be able to undo circumcision.
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I wonder if this will be more likely to change the now common practice?!?
“Circumcision Causes Lifelong Harm, Concludes New Research
U.S. attorney warns doctors, “The foundation is well laid for lawsuits.”
BOSTON (Monday, June 24, 2002) – A new study on circumcision in the latest
edition of Journal of Health Psychology concludes that the surgery causes a
host of psychological problems-including Post-Traumatic Stress Disorder
(PTSD)-in adults who have suffered the surgery as babies. The study is due
on doctor’s desks this week.
“Half of all men who were circumcised as babies have some degree of PTSD.”
http://www.facebook.com/l.php?u=http%3A%2F%2Fwww.prweb.com%2Freleases%2F2002%2F06%2Fprweb41148.htm&h=BAQHUhSyyAQGfnL3zZWa-AKupfMpMor1aQTxBuG5bNPV8qw
And it seems to me, while nothing else was able to change things, this indeed may be able to do it… for these exact reasons:
“Svoboda is convinced that this study will have a major impact on
circumcision in the U.S. “Doctors ignore a lot of medical literature,” he
said, “and they ignore the screams of the babies, but they listen when they
hear the word ‘malpractice.’ As a lawyer willing to sue, I’ve never had a
doctor not listen to me.”
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Well, that study was published in 2002 so it seems to have had no effect. Svoboda, it seems, was wrong.
It seems near impossible to me that you would be able to design a study that would link male circumcision to these outcomes without having a host of significant biases, the greatest of which would be selection bias. If you’re looking for people to comment on the emotional effects of their circumcision, who do you think is going to be interested in being in your study? People who think they have been harmed by their circumcision of course.
I could take a poll of every circumcised Jew I know, I bet not a single one feels harmed by their circumcision.
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It is always difficult to design and conduct a study when it concerns humans. And with epidemiological studies it is difficult to “prove” causation… Still, I am honestly surprised to see statements such as “could take a poll… bet not a single one feels harmed” from an educated person, and considering your other posts and work. And picking out only Jews in U.S. where every other male is circumcised? hopefully that was not a sing of discrimination… And even if you believe that majority would not feel traumatized (which to me is questionable), saying “no one” only helps the other side of the argument. There could always be someone. (just as “never say never”) In fact, I know for sure there was a film made by a Jewish guy, not sure but I think the title was “cut”, parts of it one could see on youtube… there were people in that video, who felt harmed by circumcision. The guy who made the film was Jewish and felt that way. And there were non Jewish people, who were circumcised and felt harmed by it. It is unquestionable that there are people who are unhappy about being circumcised, if nothing else (no other research) matters for you — then at least otherwise there would not have being any market for “foreskin restoration” devices. and the demand apparently does exist. The study is from 2002, true. Sad that things have not change dramatically. The “hope” is there, though. I remember reading about at least one resent case of a grown up child/ a man suing a doctor for the circumcision performed soon after birth, and winning it.
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Dr. Nicholas, you may be right about not much changing due to the study and/or the potential for lawsuit, but the incidence of routine infant circumcision does seem to be dropping, so maybe there has been a decrease at least partly from this study after all. It certainly hasn’t dropped precipitously, but it is steadily declining.
In regards to Ekaterina’s comment, the film-maker’s name is Eliyahu Ungar-Sargon and the documentary is indeed called “Cut”.
And while there may be “selection bias” in studies so far regarding PTSD and routine infant circumcision, I think a study could be constructed that would not necessarily have such a bias. Pick random men and give them a lengthy questionnaire, including asking if they were circumcised, and if so when (at birth, as a child, teenager, or adult), and ask them if they endured any known traumatic event such as might induce PTSD, and ask them about any PTSD symptoms and the severity thereof. The questionnaire would also include other things not related to PTSD and circumcision so as to mask the true intent of the survey, to reduce any bias either for or against circumcision and PTSD.
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Maybe. I find it pretty hard to believe that one can have PTSD over something that occurs on the day of birth. I have no memory of early infanthood. I suspect no one does, and perhaps even that such long term memory storage is not yet possible at the neurodevelopmental stage a newborn is in.
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A lack of memory does not make it permissible to do other things to children (or amnesiacs for that matter). If a woman is drugged and a man has sex with her when she is unconscious, he is guilty of rape, whether she remembers it or not. And that is the key point; whether someone develops PTSD after some sort of attack is incidental, but the fact that the person was assaulted and violated (whether s/he remembers it or not) is uppermost.
Still, there are many stories of children who remembered things that occurred the day they were born or soon thereafter, that they were never told about. Sure, it’s possible that they’re making it up, but it’s also possible that they do remember it. It need not be a vivid, conscious memory (though I got chills when I read about the little boy that accompanied his mother to her OB appt when she was pregnant again, and he shrank in fear from the OB when he came into the room, telling his mom that that was the man who had hurt his penis — the OB had performed the boy’s circumcision as a newborn), but it could be that the body remembers it, even if the mind has forgotten. And even without a conscious memory, undergoing things as an infant does affect the baby, perhaps forever. You don’t know what you’d be like had you not been circumcised. Perhaps nothing would be different, but just perhaps you were affected in a way that you just don’t know.
Some months ago, I watched an interview with an American woman who had been circumcised as a young girl, not an infant. I think she became a psychologist or psychiatrist or something, and she discovered in the course of her research that very many men had scary dreams of being trapped, caught, unable to run away, and a feeling of helplessness, but almost no women did. Yet she did. She believes that these dreams that she and those men had were due to their having been strapped down, helpless, unable to run away, while their genitals were cut.
It’s an interesting theory, but probably nearly impossible to prove one way or another (except perhaps as a study similar to the one I described above). Yet it must remain that that is a possibility, and given that, along with the numerous other arguments given above, and the risk of death from this cosmetic and completely unnecessary surgery, that becomes an extremely heavy burden on you to determine that every single one of these risks and negatives things will certainly not happen to any boy you cut.
I’d like to ask you a question: is there anything that might or would change your position on circumcision, or is your mind made up, so don’t bother confusing you with the facts?
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2011 CNN Hero of the Year Robin Lim on circumcision:
“Circumcisions are also not a good thing to do. It’s horrible! It’s medically sanctioned, sexual child abuse. You’re cutting over a thousand nerve endings. Everybody’s brainwashed by the medical profession. The American Pediatric Association, they came out with an official statement that circumcision was not recommended. Then they reversed their decision. You know why? Multi-million dollar business. The insurance companies pay for it. So they’re not going to deny their brothers this big income. They’d rather hurt children than to deny the business of medicine. For most women, going to the doctors mean they’re getting pre-natal scare, not pre-natal care.” (Read more…)
http://www.mb.com.ph/articles/358871/the-gentle-warrior
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Dr. Fogelson has admitted that he was circumcised as a baby. From this we can deduce that he has NO personal knowledge of the anatomy and physiology of foreskin and its many functions, which include protective, immunological, sensory, and sexual functions. We can also deduce that he is likely to have a need to defend his personal loss of those functions by pretending that he has no loss. Denial of loss is the first stage of grief.
He also should admit that medical doctors in the fields of obstetrics, pediatrics, and family practice earn compensation from doing circumcisions and this is an additional source of conflict of interest and bias on the part of many doctors and medical trade associations such as ACOG, AAP, and AAFP.
Furthermore, it is clear from Dr. Fogelson’s remarks that he has not read the medical literature from several nations that show a substantial degradation of sexual functions in both the male and his female partner that are caused by circumcision.
It is also clear from Dr. Fogelson’s remarks that he has a legal, ethical, and moral lapse in that he fails to understand that everyone has a legal right to their body parts and that circumcision, which amputates a functional and useful body part, violates that right when carried out on a non-consenting minor.
Dr. Fogelson’s blog post serves as an example and reminder of much that is wrong with medical practice in the United States.
George Hill
Vice-President for Bioethics and Medical Science
Doctors Opposing Circumcision
Seattle, Washington 98107-4137
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Thanks for your comments.
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Mr Hill – you might notice that most of your post attacks me personally rather than talking about the issue, a fairly typical sign of a radical that has lost perspective.
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The crazy thing is that the victims of circumcision are also the defenders of circumcision. I guess it is a bit like Stockholm syndrome, however it works a bit differently.
A man’s sense of well-being and self-image is caught up in the state of his phallus. If the phallus is injured then his manhood has been degraded. One must never admit to having a less than perfect phallus or risk having bad feelings about one’s self.
This makes it impossible for many circumcised men to acknowledge any loss at all, even though the annular circumcision scar is clearly visible. It is said that denial of loss is the first stage of grief. Most American male doctors suffered loss of their foreskins as infants and many have a psychological need to recommend non-therapeutic circumcision.
Many circumcised men are caught in that first stage of grief and that may be where Dr. Fogelson is today.
We also see that Dr. Fogelson has a Jewish heritage. Use of claimed but unprovable medical benefits to defend ritual circumcision is of long standing and started in 19th century Germany when ritual circumcision came under attack as being barbaric.
American doctors who are Jewish have long engaged in this same sort of rhetoric – using claimed medical benefits to defend ritual circumcision and promote circumcision for non-Jews in clear violation of the child’s human rights. Some notorious examples include Abraham Wolbarst, Eugene Hand, and Edgar j. Schoen. Dr. Fogelson is not alone is this endeavor.
He should acknowledge that he is defending ritual circumcision, which is still under attack as being barbaric.
George Hill
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Thank you for your comments. You present a non-disprovable idea, which is that a circumcised man who claims no disability from his circumcision is unaware of what he is missing. Of course this is true, but is not really a viable method of debate. Your supposition that I am frozen in the first stage of grief is curious, given that I have experienced the joys and griefs of life in many other areas without such periods of frozen development.
I can clearly say that I have no bad feelings about having been circumcised whatsoever, and have nothing but feelings of perfectness for my phallus. The idea that you think you know another person’s feelings better than they do is pretty ridiculous you must admit.
In the Jewish culture it is something that is done for ritual purposed, prescribed quite literally in the Torah. You like to compare this to ritual circumsion of women, which is not something that is prescribed in a religious text at all.
That said, it is still a reasonable comparison of sorts. As I said in my original post, it is an area of debate, with neither side having a monopoly on the truth.
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Plenty of the people who practise ritual circumcision of women claim it’s prescribed in religious texts, and that it’s “honorable” for women. The Muslim Brotherhood are trying to get it decriminalized again in Egypt for example, and Mohammed is alleged to have said: “Do not cut severely as that is better for a woman and more desirable for a husband.”
Here’s a blog where a Sunni Muslim woman said it was compulsory for her to have (a minor form) of FGC done to her daughter :
http://aandes.blogspot.com/2010/04/circumcision.html
(3rd comment)
Why would the procedure in that link be illegal in most western countries, yet this is legal:
Since your original post btw, this has been published:
Bronselaer et al, 2013
http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2012.11761.x/abstract
” For the glans penis, circumcised men reported decreased sexual pleasure and lower orgasm intensity”
and you may not have seen this one:
Frisch 2011
http://ije.oxfordjournals.org/content/early/2011/06/13/ije.dyr104.short
“Conclusions Circumcision was associated with frequent orgasm difficulties in Danish men and with a range of frequent sexual difficulties in women, notably orgasm difficulties, dyspareunia and a sense of incomplete sexual needs fulfilment.”
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International doctors’ organizations condemn the AAP’s stance on circumcision
A newsworthy story about the condemnation of infant male circumcision has occurred in the past few months. This is groundbreaking and historic because 38 doctors representing various international medical associations have condemned the American Academy of Pediatrics 2012 stance on infant male circumcision. When was the last time you have heard of so many doctors and their organizations condemning another doctors’ organization?
I am including a reference to the American Academy of Pediatrics own journal which presents the international condemnation of the AAP:
Cultural Bias in the AAP’s 2012 Technical Report and Policy Statement on Male Circumcision
Click to access peds.2012-2896.full.pdf
http://knmg.artsennet.nl/Nieuws/Nieuwsarchief/Nieuwsbericht-1/International-physicians-protest-against-American-Academy-of-Pediatrics-policy-on-infant-male-circumcision.htm
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Circumcision is the biggest unsolved problem in the social psychology of sexuality. Routine infant circumcision is the most controversial topic in American pediatric medicine.
RIC is seriously problematic for the 3 following reasons:
1. Only one country subjects a majority of newborn males to RIC: the USA. South Korea circumcises boys, not babies. Israel circumcises for religious reasons. In Australia and Canada, RIC is a minority practice. In the other advanced nations, RIC is nonexistent.
2. Most American doctors perform RIC without first injecting lidocaine and allowing 10-15 minutes for it to have full effect. This should be actionable.
3. Even though the USA has circumcised newborn and young boys since the 1880s, there never has been a study, based on a large random North American sample, of the possible sequaliae of RIC for adult sexual pleasure and function. I hasten to add that under current biomedical technology, the quantification of sexual pleasure is not possible. But we most definitely can measure the possible correlation of circ status with PE, ED, vaginismus, female anorgasmia, jackhammer sex, and more. How many circumcised adult American men have a damaged penis, starting with too much having been cut off? Finally, no American study has ever asked women who admit to having been intimate with both kinds of penises, to comment on the merits and demerits of each kind. The data lacuna described in this paragraph, I find especially disturbing.
Why do I care about this? Because I can assure you that much of what I experience when my wife and take a stroll in Venus’s Garden, I experience thanks to fiddly bits I would not have had I, like the vast majority of men of my place and time (who were almost all gentiles, I might add), been circumcised at birth. The natural penis greatly facilitates masturbation and digital foreplay, and interacts very nicely with his and her lubrication. With the natural penis, a gentle loving style of penetrative sex comes naturally. I have concluded that American RIC is an iatrogenic disaster.
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Dr Fogelson: You say you are an atheist. I surmise you have no interest in belonging to a temple. I invite you and your spouse to let your sons decide the fates of their own foreskins. Having made a tearful goodbye to your own foreskin when you were a week old, you are ill equipped to decide the sexual merits — or lack thereof == of the tender fiddly bits Nature has put on the end of the male organ.
You know that teen wrestler with the weird dick you encountered in the locker room? That could have been me 50 years ago. Except that the gentile boys around me had no clue there was such a thing as a long sleeve on the short arm. They would have been even more shocked than you were.
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Dr. Fogelson:
Ear piercing removes no human tissue and alters no physiological functions. It cannot be compared to male circumcision which extirpates human tissues and destroys its protective, immunological, sensory, and sexual functions.
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Dr. Fogelson:
Let me start by saying i think you are a nice guy, however we differ about male circumcision.
In your initial post you conclude:
“They can make up their own mind. I just wish people would treat this issue the same way. Everyone is free to circumcise their child or not, and the boy will grow up just fine either way.”
You obviously have a blind spot, perhaps caused by our own emotional issues related to your own circumcision.
It is increasingly clear that boys do not grow up fine either way. They have sexual and emotional issues related to their circumcision.
http://www.cirp.org/library/sex_function/solinis2007
Click to access 2011-06_Frisch.pdf
Click to access 2012-02_Podnar.pdf
http://www.cirp.org/library/psych/rhinehart1/
http://www.cirp.org/library/psych/goldman
Furthermore, new legal research concludes that parents do not really have a right to impose non-therapeutic circumcision upon their child.
Click to access Adler_Formatted.pdf
Finally, medical doctors also have issues caused by male circumcision.
http://www.circumcision.org/policy.htm#
You are not immune.
George
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Its one of these areas where a population of people who has been indoctrinated into a certain way of thinking feels a sense of loss over something they never knew was there. I see the same thing to some extent among women who strongly desire a natural childbirth but for one reason or another have to have a more interventional birth for the protection of their child. Some of them feel a tremendous sense of loss, something not experienced by women having exactly the same birth but never having developed a strong affinity for a ‘natural’ birth. Both had the same thing, yet only one feels loss. I can say that I feel no loss over my foreskin, but perhaps others do, if they we acculturated into a world where having one gives great meaning. Among Jews not having one is ascribed great meaning.
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Dr Fogelson: the vast majority of us out there in the blogosphere have no Jewish ancestry. And so Jewish men nowadays reject the Jewish disdain for the male foreskin. Note that two commenters in this thread have Jewish surnames. I know one of those men, and so can assure you that he is an American baby boomer and hence has lived his life surrounded by men, gentiles as well as Jews, having bald penises. Even so, he cannot accept the demonisation of the foreskin.
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International doctors’ organizations condemn the AAP’s 2012 stance on circumcision.
It is now more than a year after the anniversary of the AAP’s statement on circumcision. The AAP’s statement was made on August 27, 2012. It is time to learn about the condemnation of the AAP’s statement on infant male circumcision by 38 doctors representing more than 16 international medical associations. This is groundbreaking and historic. Why? When was the last time you have heard of so many doctors and their organizations condemning another doctors’ organization?
I am including a reference to the American Academy of Pediatrics own journal which presents the international condemnation of the AAP:
Cultural Bias in the AAP’s 2012 Technical Report and Policy Statement on Male Circumcision
Click to access peds.2012-2896.full.pdf
http://knmg.artsennet.nl/Nieuws/Nieuwsarchief/Nieuwsbericht-1/International-physicians-protest-against-American-Academy-of-Pediatrics-policy-on-infant-male-circumcision.htm
What is in the best interest of the child? It is in the best interest of the child
1) to become educated and aware of what the foreskin is and what its functions involve before cutting it off,
2) to consider the stereotypes and why they exist before cutting the foreskin off,
3) to consider if any men circumcised in infancy have been harmed by the procedure since the newborn could possibly become one of these men in the future, and
4) to avoid cutting off any body part if other less invasive means to care for that part of the body are available.
5) to learn the easy care of the foreskin which is healthier than circumcision. A) Do not pull the foreskin back. Let nature take its time. B) Do not use harsh soaps or bubble bath. C) Give your child a regular bath. As easy as ABC!
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The rules of medical ethics prohibit physicians from circumcising healthy boys. Circumcision violates the cardinal principle of autonomy (which requires all deferring procedures that can be deferred, like circumcision) and the Hippocratic Oath, “First, Do No Harm”. It also violates the rule that the benefits of a procedure must exceed the risks and harm, whereas circumcision risks serious injury and death, and harms all boys and men (e.g., invading healthy tissue, removing health of the penile covering, impairing men’s sex lives, and leaving a scar are harmful), without benefiting the vast majority of boys or men at all. (Even American medical associations concede that at best, circumcision has a 1 in 100 chance of preventing a single urinary tract infection, a 1 in 900 to 300,000 chance of preventing penile cancer, and a 1 in 67 chance of preventing HIV, in Africa, for a short time, according to studies which have been criticized as seriously flawed, and whose results conflict with the real world). This is to admit that the chance of any boy or man benefiting from circumcision is very small. Physicians also cannot perform any medical procedure when the same benefits can be achieved more effectively or safely without it. UTI’s can be treated with antibiotics; penile cancer can be prevented by washing and not smoking; and circumcision does not prevent HIV. Most men do not have sex with HIV infected women, and the few who do must still use a condom, which is almost 100% effective. Physicians also are not allowed to perform unnecessary surgery on minors, or to discriminate on the basis of gender. Physicians who are circumcised, Jewish, or both, and who are paid, are also plainly biased, and the rules of medical ethics require that ethical conflicts be resolved in favor of the patient, not the physician. The relationship of a physician to his or her patient is one of utmost trust. The physician’s duty is to the patient alone. Physicians who circumcise violate many ethical rules and dishonor their profession.
In my opinion as an attorney, male circumcision is illegal in the United States. It violates the Equal Protection Clause as female genital cutting is a federal crime. In addition, every American (all boys and girls, and all men and women), have inalienable rights under the common law, constitutional law, and human rights law to personal security (intact bodies and genitals), to autonomy or the freedom to pursue happiness however they choose (all boys say no to circumcision, and men rarely elect it for themselves), and to freedom of religion. Physicians cannot lawfully operate on healthy boys, or take orders from parents for religious, cultural, or personal reasons having nothing to do with medicine. Parents’ religious and other constitutional rights do not extend to cutting off parts of their children’s bodies. The Supreme Court settled in 1944 that parents cannot risk harming, let alone actually harm children, as circumcision does, for religious reasons. In fact, physicians and parents have a legal duty to protect their children from circumcision. Male circumcision also violates the child abuse statutes in every state and is as criminal as female genital cutting.
See Peter W. Adler, Is Circumcision Legal? 16 Rich. J.L. & Pub. Int. 439-83 (2013). Available at http://rjolpi.richmond.edu/archive/Adler_Formatted.pdf and the citations in the article.
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Thanks for your comment. I read your treatise on the legality of circumcision. You make some good logical arguments, but the whole thing seems strange given that in fact, infant male circumcision is not illegal. I think that societal norms and lack of prosecution by any legal body makes that pretty clear.
You have a particular view of the medical benefit of circumcision that is not shared by all. A recent publication looked at the economic harm caused by non-coverage of circumcision my Medicaid compared to the additional cases of HIV that would result from a across the board policy of non-circumcision, and found circumcision to be an economically beneficial thing to cover.
See: Infect Dis Obstet Gynecol. 2012;2012:540295. doi: 10.1155/2012/540295. Epub 2012 Oct 18.
The cost of Medicaid savings: the potential detrimental public health impact of neonatal circumcision defunding.
Andrews AL, Lazenby GB, Unal ER, Simpson KN.
But to make my original point, I am not necessarily a huge proponent of infant male circumcision. I am, however, a huge proponent of people doing whatever the they like and focusing on far more important issues.
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I’d agree that male circumcision is legal in the USA, but here in the UK, the BMA’s position statement on male circumcision talks at length about legal issues. Here is the summary:
“4.1.1 Summary: the law
Male circumcision is generally assumed to be lawful provided that:
• it is performed competently;
• it is believed to be in the child’s best interests; and
• there is valid consent (see below).
The Human Rights Act may affect the way non-therapeutic circumcision is viewed by the courts. There has been no reported legal case involving circumcision since the Act came into force. If doctors are in any doubt about the legality of their actions, they should seek legal advice.”
Click to access Circumcision.pdf
Here’s a link to the paper you reference:
http://www.ncbi.nlm.nih.gov/pubmed/23125519
It starts off by assuming this though:
“assuming circumcision provides 60% protection against HIV transmission to males and 46% protection against male to female transmission …”.
There is plenty of evidence which suggests that both those assumptions could be very wrong.
From a USAID report:
“There appears no clear pattern of association between male circumcision and HIV prevalence—in 8 of 18 countries with data, HIV prevalence is lower among circumcised men, while in the remaining 10 countries it is higher.”
Click to access CR22.pdf
Other countries show the same “anomaly” including Puerto Rico and Malaysia:
http://onlinelibrary.wiley.com/doi/10.1111/j.1743-6109.2012.02871.x/abstract
http://web.archive.org/web/20100729013444/http://mmail.com.my/content/39272-72-percent-aidshiv-sufferers-malaysia-are-muslims-says-council
It is unclear if circumcised men are more likely to infect women. The only ever randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60998-3/abstract
The numbers were too small to show statistical significance, yet they stopped it early, even though no such trial can be repeated, since it would be deemed unethical. Somehow though, it’s ok to plan to divert two billion dollars of funding to circumcise 38 million men in Africa without knowing whether circumcised HIV+ men are 54% (0%??, 108%??) more likely to infect women.
This 1993 study did show statistical significance, and found that “partner circumcision” was “strongly associated with HIV-1 infection [in women] even when simultaneously controlling for other covariates.”
http://ije.oxfordjournals.org/cgi/content/abstract/23/2/371
I too am a proponent of people “doing what they like”, but to me, that should stop short of genital surgery on infants, and I happen to believe it is an important issue. It became a lot more important when people started promoting it in Africa to prevent HIV, and I genuinely think that male circumcision result in more AIDS deaths than fewer.
There’s a zero-tolerance approach to genital cutting of girls, and I don’t recall too many people telling the campaigners at the time against that they should focus on far more important issues, so why the double standard?
There’s some evidence that some forms of female circumcision may protect against HIV btw:
Stallings 2005
“A lowered risk of HIV infection among circumcised women was not attributable to confounding with another risk factor in these data.”
http://www.iasociety.org/Default.aspx?pageId=11&abstractId=2177677
Kanki et al. reported that, in Senegalese prostitutes, women who had undergone female circumcison had a significantly decreased risk of HIV-2 infection compared to those who had not.
http://www.ncbi.nlm.nih.gov/pubmed/1442755
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There are many medical and law enforcement procedures that are efficaceous… and unethical. We intactivists go further: routine circumcision is inefficaceous. It is a blunt fact that STDs, including HIV, are less common in intact Europe and Japan than in the circumcised USA.
People doing whatever they like includes males deciding when they are adult what their penises look like and function.
If circumcision is unimportant, then why do it? Circumcision is in fact important, because it is a major alteration of the parts of the male body that are most directly involved in sexual acts, and sexual acts and the pleasure they afford are per se important. The claim that what circumcision removes is immaterial to sexual satisfaction is easily refuted by talking to women who’ve been intimate with both kinds of men. There are no studies, based on large random samples, of the possible correlation between circ status and PE, ED and vaginismus. Until such studies have been carried out and scrutinised critically, RIC remains unethical.
I bet that Andrews et al (2012) extrapolate to the USA, the dubious findings of the African clinical trials. Those trials were badly designed, badly executed and badly analysed. Finally, the whole discussion of the merits of routine circumcision is innocent of risk compensation. Look that up in Wikipedia. We do not know whether circumcised men are more or less likely to use condoms. Until we know the answer, all talk of circumcision to curb AIDS is futile.
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A syllogism is only as good as the premises. The premise in this article’s syllogism is that circumcision prevents HIV infection. While there are studies that purport to prove this, in practice it does not work, as a higher incidence of HIV is being found in circumcised males.
Therefore, the whole article is flawed because its conclusions cannot hold up due to its flawed premise.
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In the realm of sex, we most definitely cannot countenance letting people (including parents) do whatever they like. This would have deplorable consequences, for a host of obvious reasons. American medicine and sexology has been blind for 100 years to the occasional adverse consequences of routine infant circumcision, a practice that is common only in the USA. During the second half of last century, The UK and New Zealand gave up RIC entirely. In Australia and Canada, what was an unquestioned practice 50 years ago, is now a minority practice critiqued by the national medical society. Japan and continental Europe have never circumcised routinely. There is no evidence that western societies that circumcise large numbers of males (Israel, South Korea and USA) are healthier than those that do not (all others).
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Thumbs up to Peter Adler!
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It’s also important to remember that infants — even in America, where doctors are supposedly well-trained, and where antibiotics, blood transfusion, and other top-notch forms of healthcare are easily available — with some frequency are subjected to extreme loss of penile skin (which sometimes manifests as excess scarring, hairy shaft in adulthood, buried penis, or bent/curved penis), the risk of infection (which can get worse, especially in an era of MRSA, and potentially cause the loss of the entire member), hemorrhage (potentially leading to death, esp. if disposable diapers mask the extent of the blood loss), or losing part or all of the penis in an especially botched circumcision. Just recently, a Memphis, TN, mother was reported to be suing the hospital on behalf of her son because (as near as I can tell from the brief news account) much or all of his penis was cut off during his “routine” circumcision.
While I understand that such major negative side effects including death are thankfully rare, they are 100% avoidable because circumcision is an unnecessary cosmetic procedure done to please the parents, rather than the owner of the penis. The child is the one subjected to the pain, amputation, and possible risk of infection and long-term consequences, as well as the possible loss of life and functioning penis. When this is done for little to no actual medical benefit for the child (as opposed to some hypothetical current or future benefit, like the possibility of eliminating 1 UTI for every 100 circumcisions done, or possibly lowering the risk of sexually transmitted disease **fifteen years from now**, or maybe lowering the risk of penile cancer **in seventy years** [which many male babies will not even live to see]), then it is all risk for no reward.
I have no beef with my parents for choosing to have my chest split down the middle, leaving an ugly scar the length of my sternum, because that *was* for my good, and I almost certainly would have died had I not had that heart surgery. But to surgically alter my son’s penis because I think “circumcised penises look better”, and to risk HIS pain, HIS infection, and even HIS death for the sake of MY view of “beauty”?? Since such a thing is not done for his *certain* or even *likely* benefit, but only for cosmetic reasons and a slim, hypothetical medical benefit that most likely will not ever be realized in his lifetime, that is outside the scope of parental choice.
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Good comment.
When the scalpel and the human body meet, things can and do go wrong. Not all surgeons are maximally competent, the best of surgeons make occasional mistakes, and patient peculiarities can turn a routine well executed operation into a botched outcome.
Believe it or not, there are no studies, based one large random samples, of the adult anatomical and sexual outcomes of American and Canadian routine infant circumcision. The AAP’s 2012 Technical Report admitted as much, yet unaccountably opined that the “benefits outweighed the risks”. This is an unconscionable situation.
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Roger:
The AAP apparently charged the Task Force on Circumcision with the duty to get more money for doctors. They apparently had the attitude of “Children be damned, we need more money.”
They even appointed an insurance expert to the task force to make sure that the insurance companies did not delist non-therapeutic circumcision of children from the list of covered services.
Click to access 2013-04-24_Commentary.pdf
Parents and ethical medical doctors should not pay the least attention to the 2012 Circumcision Policy Statement.
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There are ways of “knowing what is lost” when we begin a restoration process we (the mutilated male) begin to get sensation back that was not there before due to the mutilation. “First the truth will piss you off, then it will set you free” so I am to blame the person telling me the truth about my feelings of being victimized not the perpetrator of the initial act? That is misdirected and misguided. We are pissed because later in life we found out about what was done to us. If it were a woman in the same situation it would be no different. Why shouldn’t I be pissed that some asshole of a Dr decided to take part of my manhood? Why would you assume that sex with 10,000+ more nerve endings and an extra nerve that is solely for the perpous of pleasure and reproduction is the same as someone who had these removed. Why should I be happy that the Dr. Took an extra 2″ of length from what my penis should be. It is a person who is out of touch with themselves that doesn’t “know” how to feel when violated. Circumcision creates ED and that is taking away the function. If an adult finds that restoring foreskin helps to reduce ED then why would they not know what was lost?
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I haven’t commented here for quite a while, so I’ll keep it short.
“Circumcision creates ED”
No it doesn’t, even if you say it does. You can’t just say something that is not true and think that makes it true. There’s plenty of data on this.
“There were no significant differences in sexual desire (odds ratio (OR): 0.99; 95% confidence interval (CI): 0.92-1.06), dyspareunia (OR: 1.12; 95% CI: 0.52-2.44), premature ejaculation (OR: 1.13; 95% CI: 0.83-1.54), ejaculation latency time (OR: 1.33; 95% CI: 0.69-1.97), erectile dysfunctions (OR: 0.90; 95% CI: 0.65-1.25) and orgasm difficulties (OR: 0.97; 95% CI: 0.83-1.13). “
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Why don’t you finish quoting the rest of that abstract? Could it possibly be because you don’t like what it says? Here’s the next line:
“However, these results should be evaluated in light of the LOW QUALITY OF THE EXISTING EVIDENCE and the SIGNIFICANT heterogeneity across the various studies. Well-designed and prospective studies are required for a further understanding of this topic.”
IOW, the best they’ve got is admittedly poor quality and not authoritative.
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Sure, but is some evidence, not no evidence. Having an idea you think makes sense and then declaring it true because it makes sense to you isn’t science, its pseudoscience. Real science is having an idea and then testing it with a study or trial, and being willing to accept the answer as more information than you had before.
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” Having an idea you think makes sense and then declaring it true because it makes sense to you isn’t science, its pseudoscience.”
Then American medical thinking re routine infant circumcision is pseudoscience, for two major reasons. One, the belief that infants do not experience pain in a way anologous to the way children and adults experience pain. Two, the belief that circumcision has no adverse consequences for the adult experience of sex. There is no evidence whatsoever for either belief.
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What article are you citing? Is it a meta-analysis? Was the study carried out in Uganda, using men taking part in an HIV clinical trial?
Sexual desire and orgasm difficulties cannot be measured and hence statistical analysis is meaningless. The confidence interval for dyspareunia is weirdly large, in a way that calls the exercise into question. The other data are based on oral self-report, which needs to be taken with a grain of salt.
Much about male sexuality has yet to be well researched and hence is not well understood. This is triply true insofar as the foreskin is involved. This is not grounds for concluding that circumcision is not guilty of anything, but is grounds for concluding that the safety of RIC has yet to be demonstrated.
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In 2012, the AAP issued new recommendations that promote circumcision, thereby contradicting the AAP’s own statement in 1971, “There are no valid medical indications for circumcision in the neonatal period”, which is the prevailing view today among physicians and medical associations in the Western world outside the United States. As Roger Desmoulins wrote, 38 distinguished European physicians criticized the AAP’s 2012 position as medically, ethically, and legally untenable. http://pediatrics.aappublications.org/content/early/2013/03/12/peds.2012-2896.
Then in December 2014, the CDC issued draft circumcision recommendations – without following several required procedures for important medical assessments, so they will be legally invalid if enacted – that are essentially the same as the 2012 AAP recommendations. According to Van Howe, both reports were written by a “Who’s Who” of circumcision advocates, possibly the same consultants. The CDC was listed as a consultant to the AAP in 2012. In any event, if the CDC had been honest, objective, and scientific, as per its mandate, mission, pledge, and responsibility – the CDC is not advising witch doctors – it would have acknowledged and answered all of the criticisms of the AAP made by the 38 European physicians, all of which applied to the draft CDC recommendations. But it didn’t. This was a cover-up. If the European criticisms could have been answered, the CDC would have addressed them. Whatever the reason, the CDC had a duty to respond to the European critique.
This came to the attention of the 38 European physicians. 31 of them left the following public comment to the 2014 draft CDC recommendations. It was remarkable enough that in 2013 these European physicians representing medical associations throughout Northern Europe criticized their medical brethren in the U.S.. But the second time, in early 2015, they were not so polite:
“[T]he way from the [CDC’s background paper to the [CDC’s recommendations is marked by exclusion, omission and minimization of scientific peer evidence that does not support the recommendation. This is very similar to the development of the AAP circumcision policy statement in 2012 in which critical evidence was omitted or downplayed. A group of 38 distinguished physicians from European and Canada, comprising several heads and representative of national medical associations, societies for pediatricians and pediatric surgeons, and medical ethics board, published a comprehensive and evidence-based reply to the AAP recommendations, which has not been considered by the CDC (Frisch et al 2013).
Moreover, there are irreconcilable differences between the CDC’s recommendations and its background materials. E.g., the CDC recommendations as to what physicians should tell 2 million parents and about 34 million heterosexually active adolescent boys and men says nothing about sexuality, while the background materials concede that circumcision may impair men’s sex lives. The parents, adolescents, and men to whom physicians will be pitching circumcision have a right to know that. Actually, they have a right to know that circumcision will destroy normal sexual function and impair their sex lives. The draft CDC recommendations also claim that circumcision will significantly and dramatically decrease HIV in the United States, when the absolute risk reduction claimed in Africa is only 1.3%, and by the CDC’s own admission there is no evidence to support that circumcision will reduce HIV in the United States. We have already tried the experiment of circumcision virtually every male in the United States (over 80%), but the U.S. has a much higher circumcision rate than in Europe where most men are genitally intact. By the CDC’s admission, even if the 1.3% reduction occurred here, for which there is no proof, only hundreds of men would benefit, offset by the number of women who would acquire HIV during wound healing, and the number of men who would acquire HIV as a result of risk compensation, more anal sex, and less use of condoms.
The AAP and the CDC, by not addressing serious criticisms, and by excluding, omitting, minimizing, and overstating critical evidence, by not disclosing in its recommendations critical conclusions in its background materials, and by failing to address the central issue of who has the right to make the circumcision decision (the person whose body part is being irreversibly removed or his parents), has committed unconscionable violations of the ethical and legal duties of physicians to patients. The CDC has done its homework and reports that the number of circumcision will increase if its recommendations are enacted. The result will be massive numbers of injuries, some serious and fatal, more cases of HIV, and every one of these boys and men will lose the most sensitive part of his penis for life.
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Good comment, Peter.
I should add, though, that the European letter in Pediatrics did itself a serious disservice by arguing that American medicine suffers from “cultural bias”. Doctors are not trained social scientists and hence should not argue for or against anything by invoking cultural bias. The fundamental problem with the AAP’s 2012 stance (and the CDC’s desire to echo that stance), is that we simply don’t know enough about how the foreskin matters for sexual pleasure and function, to have any business cutting it off. We don’t know, because there is very very little relevant North American research. But absence of evidence (of harm) is not evidence of absence (of harm). Opponents of RIC do not need to show that RIC is harmful. Rather, advocates of RIC has to show, in a convincing manner, that RIC does not detract from sex. They have completely failed to do this. Meanwhile, there is ample anecdotal evidence in social media that circumcision can detract from normal marital sex. I am deeply dismayed that Professor Douglas Diekema, a supposed authority on medical ethics and a star member of the AAP’s 2012 Task Force, cannot see this.
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When doctors, the AAP, and the CDC speak, whatever they have to say, journalists publis it, and largely uninformed parents believe what they say, So presently the burden of proof in on those who are opposed to circumcision. But that’s backward. The foreskin has evolved over 50 to 100 million years. If there were anything defective about the sexual organs, evolution would have eradicated it. Moreover, genitally intact men in the U.S. rarely volunteer to be circumcised, so physicians cannot impose it upon them against what they would choose if able to choose. Thus, the burden is those wielding the knife, their trade associations, and the CDC to prove that circumcision is medically, ethically, and legally justified, and that there are no safer, more effective alternatives to it. They cannot meet this burden. The benefit of any doubt must go helpless children who must live with the consequences of circumcision.
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The very substantial dichotomy in the views of the American medical community and the medical communities of Australia, New Zealand, Canada, the United Kingdom, Holland, Germany, Poland, Sweden, Norway, Denmark, Finland, Russia, France, Spain, Italy, and other countries clearly indicates that the American medical community has a unique bias in favor of infant male circumcision that is not found anywhere else in the world.
The cause of this bias, in my opinion, is three-fold.
1. Most male American doctors were circumcised at birth, which creates a natural bias in favor of circumcision, because one needs to defend one’s status, whatever it may be.
2. American doctors who perform infant circumcision must justify the practice ethically and medically.
3. American doctors who perform infant circumcision profit financially from the practice and have a natural desire to keep the income flowing. No one want to kill the goose that lays golden eggs.
ACOG is a very strong defender of the practice of circumcision, although it tries to blame parents. Dr. Folgelson may be a spokesperson for ACOG, since he is an OB-GYN.
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You write, “I also hear stories of how the lack of a foreskin somehow interferes with sexual pleasure. I just don’t understand how this can be verified.” It is an oft-stated legal principle that “he who avers must prove”. The law also extends special protection to children, who are helpless to protect themselves. In addition, under the precautionary principle of medical ethics, it is “better to be safe than sorry”. Accordingly, pro-circumcision medical (trade) associations and physicians who circumcise bear the burden of proving their assertion that circumcision does not somehow interfere with sexual pleasure, even though it removes specialized nerves from the erogenous penis, and also that circumcision is painless, safe, and does not cause psychological harm. They also bear the burden of proving that circumcision has the medical benefits claimed for it, that the benefits cannot be achieved more conservatively, and that parents have the right to make the circumcision decision for their sons. Boys and men would be entitled to the benefit of the doubt on all of these issues, if doubt existed.
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You are a circumcised man and therefore of course rationalize or trivial the issue. In the US the OBGYNs are making collectively hundreds of millions by performing this useless procedure. Sexually transmitted disease cannot be an excuse. How could a surgery substitute for safe sex. Actually US has MORE std than Europe where circumcision is rare.
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Totally agree. My story is exactly as yours. Everyone I grew up with was circumcised. Hungarian guy joined our class in eighth grade and he was thd butt end of jokes for his weird penis. I’ve seen some obsessed people going crazy about the benefits of foreskin but I’ve never missed mine. Not my brother cousins or any buddies. So when it came to our two sons we chose this for them based on the medical benefits and familiarity. Both done in a safe comfortable environment and no issues at all. My sister and brother the same as did all our friends. The fundamentals here are informed consent and respect for what decision you make. And ensure whoever does it it reputable. My wife’s OB was brilliant. It’s like discipline, vaccination and religion. You do your best as a parent and the last thing you want is some idiot telling you that you did it wrong. We have no regrets. And as for the attempt to compare it to female genital mutilation whose total reason is to mutilate and diminish sexual satisfaction – give me a break.
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If you’re happy to be circumcised, that’s great. It’s not like you ever had the choice though. I do, and I’d pay a year’s salary rather than be circumcised or have my son circumcised. Why would I want the most sensitive and pleasurable parts cut off? That little bit of skin makes a big difference (it’s not just there to protect the glans).
Why don’t we just let everyone decide for themselves whether or not they want irreversible genital surgery? It’s their body after all.
It’s not like it can’t wait. I think it’s only the USA (at around 60% and dropping) and Israel where more than half of baby boys are circumcised. Other countries circumcise, but not till anywhere from the age of seven to adolescence. Only about 12% of the world’s circumcised men were circumcised as babies. Around two thirds of the world’s men (including 88% of the world’s non-Muslim men) never get circumcised.
If I’d been circumcised at birth and you hadn’t though, I can easily see how we might be on opposite sides of this argument. I’d be the one who didn’t know what they were missing…
You can’t miss something you’ve never had, but there are a lot more men unhappy about being circumcised than you seem to think. Similarly, as pointed out in other comments here, there are lots of “circumcised” women who are happy to have been cut, and can’t understand what all the fuss is about.
Even if you see a fundamental difference between cutting girls and boys, the people that cut girls don’t (it’s usually cut women btw, and they get furious if you call it “mutilation”). There are intelligent, educated, articulate women who will passionately defend it, and as well as using the exact same reasons that are used to defend male circumcision in the US (religious, cultural, hygiene, cosmetic, disease prevention, and allegedly improved sex life), they will also point to male circumcision itself, as evidence of western hypocrisy regarding female circumcision. The sooner boys are protected from genital mutilation in the west, the sooner those peoples that practice FGM will interpret western objections as something more than cultural imperialism.
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Oh, please not another circumcised man says I’m Ok. So its Ok, and on it goes. No you are wrong. The foreskin rather than a demon is a part of the sexual anatomy of a normal male. It is very much like a movable sleeve with nerve and membranes that protect and give pleasure. You rationalize because its easier to do that than face that circumcision of a baby is a brutal sexual mutilation that does affect sexual pleasure. You have not the slightest study of female circumcision, which considering which culture could be just a pin prick or a removal and modification of the pleasure yielding parts of the female genitalia. So as an American circumcised man, your comments or beliefs are like an anus, everybody has one.
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Steven:
“Everyone I grew up with was circumcised.”
A fact that should give you pause.
“Hungarian guy joined our class in eighth grade and he was thd butt end of jokes for his weird penis.”
Do you see what was wrong here?
“I’ve seen some obsessed people going crazy about the benefits of foreskin but I’ve never missed mine.”
Have you stopped to think that the foreskin and its motion enhance foreplay and penetrative sex, for both parties?
“Not my brother cousins or any buddies.”
You and I have no way of knowing that.
“So when it came to our two sons we chose this for them based on the medical benefits and familiarity.”
The alleged benefits are claimed only by American medicine. Familiarity is no argument for the practice.
“Both done in a safe comfortable environment and no issues at all.”
Was lidocaine injected and 15 minutes allowed for that injection to take effect? Did you witness the circumcisions of your sons? Are you aware that there are circumcision complications that do not become apparent until after puberty or even not before middle age?
“My sister and brother the same as did all our friends.”
What region of the USA do you reside in? I doubt that all your friends were willing to discuss with you. If you asked, you risked damaging your reputation as a wholesome human being.
“The fundamentals here are informed consent…”
In no way did your sons consent to any surgery on their penises. American doctors very often do not supply what is required for informed consent, in part because American medical education is mistaken about the pros and cons of routine circumcision.
“…ensure whoever does it it reputable.”
How can people who are not doctors assess the reputability of a doctor?
“My wife’s OB was brilliant.”
How do you know that? In my opinion, a brilliant obgyn is one who declines to circumcise routinely the boys he delivers.
“It’s like discipline, vaccination and religion. You do your best as a parent and the last thing you want is some idiot telling you that you did it wrong.”
It would be nice if we could lead lives free of criticism. But a society like that would be one where law enforcement and morals would not exist. Where all adults would be self-employed, standing alone to face the harsh rigors of the market economy. An unavoidable part of living in a society similar to the one that surrounds us, is that some people will disagree with the choices we make.
.
“We have no regrets.”
Your sons will have the last word here.
“And as for the attempt to compare it to female genital mutilation whose total reason is to mutilate and diminish sexual satisfaction…”
No one will admit to a desire to mutilate their children. You and I have no way of knowing the reason(s) for FGM. There are no rules that decide whether action A is or is not comparable to action B. African women who have undergone FGM firmly deny that the intent of FGM is anti-sexual. The people (led by Kellogg and Remondino) who advocated routine circumcision in the English speaking world, late 19th century, most definitely had an anti-sexual agenda. They believed that excessive male sexual desire was the root cause of many moral and social evils, and that circumcision reduced sexual desire in men, esp. young men. This argument for circumcision faded away in the 1920s and 30s, and so has been forgotten.
Historically, women were often shamed for their sexual desire. Contemporary women know this, and that awareness sensitises them to the shaming of male desire. This may be a major reason why many prominent intactivists are women and mothers. The most important reason for my having become a defender of the male foreskin, is a book by Rosemary Romberg, who published it in 1985.
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As I said more of nothing. How was your Junior even known to students? Most boys keep their pants on and today in USA any Gym classes, No showers.. privacy. Further why di having something normal bother you? Its illogical and sorry the foreskin has been studied anatomically and only in a cut culture would anybody wish remove it. Doctors in US can tell you adult men rarely are circumcised because they want it. They are more mature than you apparently. But a baby has no choice and it is legally a sexual assault on a male infant in same way same would be said if he were a she. Its just US protects itself and blasts FGM simply because of the feminists. Its a neo liberal Clintonsonean agenda.
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