Circumcision Debate: Cut the Hyperbole
What frustrates me about the circumcision debate is that both sides exaggerate their claims. Maybe this happens with most controversies, but I am particularly attuned to this one because I have been researching the history of circumcision in the United States. A recent article by Brian J. Morris and others in the Mayo Clinic Proceedings overstates the health benefits of circumcision and downplays the risks. They argue that the public health benefits (i.e. reducing sexually transmitted diseases) are so great that circumcision should be mandatory. Mandatory?
Inflammatory statements such as this have been around for a while. In the nineteenth century, proponents alleged that circumcision prevented masturbation and syphilis.
Yes, you read that right. Physicians as well as parents believed that an uncircumcised boy would fuss unnecessarily with his penis, tugging on the annoying foreskin, ultimately leading to masturbation. In fact, some doctors looked to Jewish boys as exemplars of good morality; since Jews mandated infant circumcision, these boys, the theory went, never masturbated to excess. One doctor went so far as to say that Jewish boys only masturbated when they associated with uncircumcised boys, those “whose covered glans have naturally impelled them to the habit.”  Such a habit among Jews, he claimed, though not unheard of, was exceedingly rare. Ya, right.
With syphilis too, Jewish men stood out. Many circumcision advocates, Jews and non-Jews alike, held that Jewish men had a remarkable immunity to the sexually transmitted disease. Not all agreed, however, as some physicians had actually treated circumcised Jewish patients for syphilis. Yet Jews continued to be praised for what was seen as their hygienic practices. One nineteenth-century doctor who performed scores of circumcisions on adult men as a way to cure genital herpes suggested that this problem could be alleviated if we would “follow in the footsteps of Moses and circumcise all male children.”
Despite competing claims about circumcision’s purported benefits, the health assertions persisted, shifting from a focus on masturbation and syphilis to urinary tract infections, phimosis (a restricted foreskin), cancer, and AIDS. Today it’s easy to dismiss the threat of masturbation as a reason to remove an infant’s healthy foreskin, and even penile cancer is quite rare, but it’s harder to argue against stemming the spread of HIV/AIDS. Everyone wants to put an end to this disease, but I have to wonder if permanently altering a baby’s genitals is a likely way, or even a sensible way, to do that.
Morris is a well-known circumcision advocate, and in this article he suggests that circumcision is so beneficial that parents should consider it akin to vaccination. From his perspective, circumcision keeps the individual boy from getting urinary tract infections and phimosis as a child, and then later when he becomes sexually active his circumcision keeps him from becoming a public health risk. Hence, Morris argues, it’s like a vaccine in that it prevents future illness.
Treating circumcision as a vaccine sets us on a dangerous path. If men think that their circumcisions alone will protect them from sexually transmitted diseases, they are sorely mistaken. Circumcision may decrease the risk of some diseases (though even that is contested), but having had the procedure does not work like a vaccine—it does not confer resistance or immunity—and men still need to use condoms to protect against STIs and HIV/AIDS.
Morris says that those parents who refuse circumcision are analogous to parents who refuse vaccination for their children. While it might be true that both groups of parents subscribe to a less interventionist medical model, the two decisions are very different, and it’s inflammatory to link them. There are other ways to avoid sexually transmitted diseases–condoms, for example. Vaccines, by contrast, are our only way to prevent the spread of devastating childhood diseases like measles, mumps, rubella, and polio.
By coupling circumcision with vaccination, these researchers and advocates subtly affect our understanding of the procedure, suggesting we should lump it in with the other shots and tests that newborns routinely receive. And yet, circumcision is more than that. This sort of hyperbolic advocacy helps create a sense that it is normal, not a surgical intervention with ambiguous effects, whether beneficial or harmful. Such language clouds the vision of new parents when they face a critical decision. The words of Morris, et. al., suggest it’s not much of a decision at all–it’s a no brainer. Yet the brain is an organ that parents actually do need to keep sharp and use here.
In 2012, the American Academy of Pediatrics stated that parents should be presented with honest and straightforward information about the pros and cons of circumcision. We might ask first why parents are permitted to make this decision altogether, a choice that permanently changes a child’s body and removes healthy foreskin. But if we collectively agree that for certain reasons we should allow it, then the reasons must be really good ones.
Yet how, then, can parents make an informed decision when both sides overstate their claims? Those who advocate circumcision inflate the benefits and dismiss the risks; and those who oppose circumcision amplify the risks and minimize the benefits. For example, “intactivists” raise the issue of pain, physically at the time of the surgery and emotionally for years beyond. Certainly babies feel pain, but are they permanently, psychically scarred for life, as some intactivists suggest? That would be difficult to prove. Similarly, sensitive nerve endings are destroyed with circumcision, and so it’s likely that sexual sensitivity would be diminished, but how much that weakens sexual pleasure is hard to ascertain, since circumcised infants grow up to be men with no pre-circumcision sexual experience with which to compare their current sensation. And I’m sure many of us know circumcised men who think the sex they are having is just fine. Better than fine, even.
To me, arguments that are less prone to hyperbole are the most compelling. And in this debate I stick to what is undisputed: opting for circumcision is a decision to permanently change someone else’s body. That is a big responsibility. If we are committed to allowing parents this choice, then I would like to see them presented with the most basic and clearly stated information: what exactly happens during a circumcision? What is the foreskin for? What is being cut away? How is it done? How long does it typically take? How long does it take to heal? What does a circumcised and uncircumcised penis look like at infancy and in adulthood? Many new parents do not know even these fundamental facts. I know I didn’t.
The circumcision decision should not be made lightly, and parents should not feel pressured by exaggerated claims of benefits or risks. We owe our baby boys that much.
 Brian J. Morris, Stefan A. Bailis, Thomas E. Wiswell. “Circumcision Rates in the United States: Rising or Falling? What Effect Might the New Affirmative Pediatric Policy Statement Have?” Mayo Clinic Proceedings, 2014. DOI:10.1016/j.mayocp.2014.01.001
 M. J. Moses, “The Value of Circumcision as a Hygienic and Therapeutic Measure,” New York Medical Journal 14:4 (November 1871), 368-374
 A.U. Williams, “Circumcision,” Medical Standard 6 (1889), 138-39