Article: To Snip Or Not To Snip? Circumcision And You

I’m from the UK.

Here only about 3.8% of boys are circumcised by the age of 15 and most of us would never even question the presence of an uncut pecker in a partner’s pants.

But I hear this isn’t the case in the US.

Some US statistics estimate that up to 79% of boys are circumcised soon after birth, and this is a figure that, I have to be honest, boggles my British mind.

Most of the time these circumcisions aren’t done for medical reasons but, instead, cultural ones: the ‘go with the flow’ mentality that we all face in everyday life. A lot of Americans are circumcised and, when they have a boy, don’t want their child to feel like they’re different from their dad. Later on in life fears of locker room ridicule or mocking and rejection from sexual partners comes in to play.

Is it fair to exclude a child in such a fundamental way from birth?

The answer is not necessarily an easy one for many. Sometimes the answer will be an emotional one. But when there’s a little life involved – one whose body you’re essentially choosing to permanently alter before they can even legally consent – looking at the facts and considering the pros and cons might be the better way to go.

If you agree then here they are (with an admitted personal slant towards a proclivity to keep a person’s body intact).

What Is Circumcision?

If you’re from the States then, chances are, I’m preaching to the choir. But circumcision isn’t a very common practice worldwide (only 30% globally) so let’s look at just what it is.

(Male) Circumcision is the surgical removal of the foreskin: the foreskin being a retractable fold of skin that covers the whole penis when flaccid.

The foreskin has many uses, most of which we’ll go in to soon, but it can also occasionally cause issues. Some people thus get the foreskin circumcised to alleviate these medical concerns and allow them to live a healthy life.

Other people practice circumcision for religious reasons, cultural and social expectations, or to try and prevent the contraction of some STIs, HIV being chief among them.

Views On Circumcision

Views on circumcision vary depending on the country in question. The American Academy of Pediatrics published the following status in 2012:

After a comprehensive review of the scientific evidence, the American Academy of Pediatrics found the health benefits of newborn male circumcision outweigh the risks, but the benefits are not great enough to recommend universal newborn circumcision. The AAP policy statement published Monday, August 27, says the final decision should still be left to parents to make in the context of their religious, ethical and cultural beliefs.

Divisively the Canadian Paediatric Society have the following to say:

The Canadian Paediatric Society does not recommend routine circumcision of every newborn boy.

The UK’s National Health Service doesn’t even have an official stance on circumcision, such is the sense of irrelevancy among British medical practitioners. When talking about circumcision there is an emphasis on the fact that it is only being discussed in terms of medical terms and benefits. We don’t want to ruffle any feathers, after all (pip pip).

The Parliamentary Assembly of the Council of Europe is much clearer on the topic of male ritual circumcision, considering it a ‘violation of the physical integrity of children’ likening it to female genital mutilation (something that did not please Israel, apparently).

The Royal Australasian College of Physicians states that:

After reviewing the currently available evidence, the RACP believes that the frequency of diseases modifiable by circumcision, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia and New Zealand.

The Central Union for Child Welfare in Finland is firm on their stance:

The Central Union for Child Welfare considers that circumcision of boys that violates the personal integrity of the boys is not acceptable unless it is done for medical reasons to treat an illness. The basis for the measures of a society must be an unconditional respect for the bodily integrity of an under-aged person.

Circumcision intervenes in the sexual integrity of a male child causing a permanent change in organisms and has consequences pertaining to both health and quality of life.

The circumcision of girls is rightly considered as inhuman mutilation of the genitals and is punished abuse. Also boys must be guaranteed a similar protection by law.

An Inhumane Mutilation? Surely Not

It’s hard to think of a practice the predates many modern religions and has been largely practiced in the US as standard practice for many years as being on par with the (rightly considered) horrendous act of female genital mutilation. Especially when there are recorded benefits for circumcision.

Therapeutic or medical circumcision can, for example, have the following benefits:

  •  In the case of phimosis (tight foreskins) circumcisions may be the final option for relieving the pain of some individuals.
  • For those who suffer with recurrent cases of balanitis (infection of the foreskin and head of the penis) circumcision may also provide equal relief.
  • Ditto goes for paraphimosis (where the foreskin can’t be returned to its original position after being pulled back) which urgently requires attention to avoid restricted blood flow to the penis, and balanitis xerotica obliterans (a condition causing phimosis), which can cause scarring and inflammation.
  • The prevention of repeated urinary tract infections, but this is very rare and used as a final option.

The flip side of this, however is that many of these conditions can be treated without the need for a surgical procedure, with circumcision acting as the final option rather than a preferred go-to for many professionals.

Other health reasons for circumcision (though sometimes speculative) have been recorded as follows too:

  • A decreased risk of STIs (especially HIV and HPV).
  • A decreased risk of penile cancer (and cervical cancer for heterosexual partners practicing penis-in-vagina intercourse).
  • Ease of genital hygiene.

And then, of course, there are cultural and religious considerations, but those can vary from country to country, so we won’t dwell on them here.

Quite a Few Benefits Then?

Looking at the above, it’s undeniable that, in some instances, circumcision is necessary and, in others, may give benefits that sound desirable. But what about the cons?

Medical professionals vary on circumcision cons, but the main ones seem to be the following:

  • Can be a painful procedure (and perhaps even traumatizing, for those who get circumcised at a later age).
  • Between a 1 in 10 and 1 in 50 chance of excess bleeding or infection after the procedure.
  • Permanent reduction of sensation in the head of the penis, potentially decreasing sexual pleasure.
  • Tenderness in the scarring area.
  • An increase in the chance of meatitis (inflammation of the opening of the penis).

Among those who condemn non-medical circumcision it is generally considered that circumcision is an unnecessary surgical procedure undertaken on an individual that cannot consent to the process (which does cause long-term scarring and permanently change the physical quality of the body) and thus is not advisable. And, if I’m being honest, I can’t help but agree with this conclusion.

My Two Cents

All cards on the table, I really struggle to find the difference between non-therapeutic circumcision and female genital mutilation.

Sure, there is a variation in the amount of pleasure that one can deprive from the non-consenting individual, but pleasure will still be deprived. The person still cannot consent. And the decision (which has few universally agreed upon benefits which justify it as the standard) will be part of that individual’s life forever: a literal scarring on their lives.

Yes, cultural and religious associations may mitigate the impact of this non-consensual bodily intrusion, but it still doesn’t justify it in my mind and, although I would never judge a circumcised cock, I don’t believe it should be a widespread practice in any regard.

But What About The HIV Study?

‘Not necessary?’ you might say. ‘But what about the peer-reviewed study published in the New England Journal of Medicine which found that, in a study of 3,393 males, randomly allocated to either immediate circumcision (1,684 males) or circumcision after a 24-month wait:

The circumcised men had a 7.8% overall chance of testing positive for the genital herpes virus, compared to a 10.3% chance in the uncircumcised group (adjusted hazard ratio 0.72, 95% confidence interval [CI] 0.56 to 0.92; P = 0.008).

[And] In the circumcised group, the prevalence of high-risk HPV genotypes was 18% compared to 27.9% in the uncircumcised group (adjusted risk ratio 0.65, 95% CI 0.46 to 0.90; P = 0.009).

This sounds impressive, but the study was undertaken in Uganda, and has been criticized for its practicality in Western communities, where HIV and HPV education is more accessible, STI awareness more prevalent, and access to better, non-surgical methods (such as condoms) readily available to almost all individuals.

All of this continues to make the case for circumcision rather weak in countries that regularly practice it, even if the results may be of significant importance for individuals in Uganda.

The Lesser Of Two Evils

Throughout this article it’s clear that circumcision is a highly contentious topic. But sometimes it is necessary. In such cases what can a person expect?

Circumcision is typically carried out on the day, with no need for an overnight stay. This is the same for both children and adults (at least in the UK). In the US it may be offered in the first 2 days of the child’s birth and in some religious practices it may be undertaken later.

In the UK, the medical procedure of circumcision will be explained and a consent form signed. A general anaesthetic will be administered. This means the individual will be unconscious and unable to feel pain during the procedure.

In the US a local anaesthetic will likely be used, either as a numbing cream or an injection. A pacifier dipped in sugar water may also be used to alleviate any clear distress.

Healing after the procedure takes roughly 10 days. Immediately after ointment will be applied and a gauze used to dress the wound.

You’ll have to be gentle when bathing (or when bathing your child) and adults should avoid sex for at least 4 weeks after the procedure.

Pain relief, such as paracetamol and ibuprofen, will probably be needed for a few days afterwards.

A follow-up shouldn’t be needed except in cases of unexpected inflammation, bleeding, or other complications.

Outside of that, there’s not much more to be said in terms of the procedure which, although arguably intrusive, is at least straightforward.

Final Thoughts

Addressing principles of good practice for circumcision in the 2000’s, the British Medical Association set about a list of good practices when the procedure was being considered.

The list itself was engaging enough that I think it worth quoting here in full.

When it comes to circumcision this is what UK medical professionals have chosen to keep in mind:

  • The welfare of child patients is paramount and doctors must act in the child’s best interests.
  • Children who are able to express views about circumcision should be involved in the decision making process.
  • Consent for circumcision is valid only where the people (or person) giving consent have the authority to do so and understand the implications and risks.
  • Both parents must give consent for non-therapeutic circumcision.
  • Where people with parental responsibility for a child disagree about whether he should be circumcised, doctors should not circumcise the child without the leave of a court.
  • As with all medical procedures, doctors must act in accordance with good clinical practice and provide adequate pain control and aftercare.
  • Doctors must make accurate, contemporaneous notes of discussions, consent, the procedure and its aftercare.

Whatever one’s personal view of circumcision is I hope we can all agree that the guidelines above at lease provide a firm framework for treating the procedure with the respect, professionalism, and deep consideration that it undoubtedly requires.

When the consent is at play, in any instance, a serious acquisition and debate of all the issues involved is at least, we hopefully agree, essential.

  • Innocent Loverboy

    I wrote a post about this myself some years back.

    I’m not circumcised (and I know very few people who are; there are only a couple, and many of them are Jewish) and I genuinely can’t imagine life without my foreskin. I’ve seen a lot of foreskin hate – “eww! uncut cocks!” – but, despite talking over the subject with people, I’ve still no idea why!

    Good point about consent, too – I hadn’t thought of that!

  • Another very well-considered article, Dr Peaches. I also feel that circumcision should be consent-based, and I don’t believe that infants can consent to the procedure. However, I do understand that this doesn’t take cultural tropes into account. In South Africa, many cultures require men to be circumcised at puberty as a sort of coming-of-age ritual, and naturally there are religious preferences as well. It’s a pretty emotional topic, to be honest.