Wednesday 26 January 2011

Male circumcision: Is it neccessary?

In November 2010, CBS News in San Francisco reported on a proposal to ban male circumcision, which would make it a misdemeanor to “circumcise, excise, cut or mutilate the genitals of a person under 18.” It has catalyzed a debate about the legality of male circumcision among medical professionals, religious leaders and those opposed to ritual and medically-unnecessary circumcisions.

Male circumcision is the removal of some or all of the foreskin (prepuce) from the penis. It is generally done soon after birth of the child although there are instances when it has been done when the male is an adult although not too often and generally for religious reasons. For Jews and Muslims, it is always done for religious reasons. It is also customary in some Christian churches in Africa, including some Oriental Orthodox Churches.

There is controversy regarding circumcision. Arguments that have been raised in favour of circumcision state that it provides important health advantages which outweigh the risks, has no substantial effects on sexual function, has a low complication rate when carried out by an experienced physician, and is best performed during the neonatal period. Those raised in opposition to circumcision state that it adversely affects penile function and sexual pleasure, is justified only by medical myths, is extremely painful, and is a violation of human rights.

With respect to the circumcision being painful, I don’t think anyone doubts that however, if it is done in a hospital, I would hope that the baby or adult would be given a local anaesthetic in the area of that simple operation. Complications from circumcisions performed by experienced surgeons are as rare as those springing from dental procedures or vaccinations: that's to say, statistically negligible.

The World Health Organization (WHO; 2007), the Joint United Nations Programme on HIV/AIDS (UNAIDS; 2007), and the Centers for Disease Control and Prevention (CDC; 2008) state that evidence indicates male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex, but also state that circumcision only provides partial protection and should not replace other interventions to prevent transmission of HIV. According to one British researcher, "The foreskin of the penis is a magnet for HIV."

In 1970, some 97%of American males, and about 70% of Canadian males were circumcised. Those numbers have fallen dramatically, thanks in large part to ardent activism by anti-circumcision rights groups.

Some people believe that the Canadian government should pass legislation that would prevent religious leaders and health-care legislators from performing or authorizing the ritual circumcisions of newborn children. They base this argument on two often-adduced moral grounds: that the circumcision of infants violates their human rights, because they cannot give informed consent to the procedure, and that male circumcision is a mutilation, comparable to female genital mutilation already outlawed.

Before addressing these moral concerns, I stipulate to set aside any religious argument for this debate. I believe that Jews would unequivocally renounce the ritual of male circumcision if scientists provided a causal link between circumcision and increased risk for morbidity. But after 5,000 years of what is essentially a massive controlled study of Jewish and Muslim men, from which no negative effects can be ascribed to male circumcision, that is unlikely to happen.

The WHO's position regarding circumcision rests on a widely-hailed, uncontested South African study (randomized and controlled) concluding that ‘male circumcision provides a degree of protection against acquiring HIV infection, equivalent to what a vaccine of high efficacy would have achieved. Extrapolating from the study, it is estimated that in the next 20 years, circumcisions in sub-Saharan Africa can prevent 6 million infections and 3 million deaths.’ The study demonstrated that the surgery can be used to prevent an infectious disease.

However there are some people who would shrug off this procedure by claiming that there are far better ways to eliminate HIV, such as educating youth about sexual health and condom use. Actually, both have been tried. They don't work in significant numbers although sexual-fidelity campaigns have been effective to some degree.

Moving to the moral realm, the argument of informed consent is easily demolished by the fact that we routinely vaccinate our children against disease without their consent for their own good. Further, silver-nitrate is put onto the surface of a newborn’s eyes to prevent infection and blindness without the infant’s consent.
Even before we knew of the HIV connection, amongst those circumcising their sons, health and hygiene were always the reason. Sexually transmitted diseases are much more common in uncircumcised men, and circumcision causes a 12-fold reduction in the incidence of urinary tract infections.

On to the pernicious myth that male circumcision, a 30-second procedure, is a mutilation and the obscene canard that it is the equivalent of sexist female genital mutilation. FGM is an invasive and painful surgical procedure that is often performed without anesthetic on girls before puberty. Their prepuce is removed and their clitoris may be partially or completely removed. In some traditions the operation is far more invasive: the labia minora are also surgically removed and the labia majora are sewn together, covering the urethra and vagina. A small opening is retained for the passage of urine and menstrual fluid. This horribly protracted and painful procedure done under terrifying circumstances, with the specific intention of eliminating the capacity for sexual pleasure. The result is that sexual feelings are either inhibited or terminated. Sexual intercourse is often extremely painful for the woman. Childbirth often involves a Caesarian section. This procedure is rightly considered a criminal act in advance nations. According to UNICEF, at least 100 million women have been genitally mutilated. Compared to their uncut peers, these women are 69% more likely to hemorrhage after childbirth, and up to 55% more likely to deliver a dead or mortally ill baby. For every 100 deliveries, the WHO estimates FGM kills one or two more children. To compare FGM with circumcision is outrageous and deserving of contempt to those who would try to link the two as being equally the same.

‘Mutilation’ is an inappropriate word to apply to the excision of a non-essential bacteria trap on the surface of the penis that is nearly painless and instantly forgotten (those who claim otherwise are fantasizing; no credible study demonstrates lasting effects). Unlike ordinary circumcised men, FGM victims know they have been mutilated in the real sense of the word. Feminists constantly remind us that men have all the power. If true, how is it that after so many thousands of years—coincidentally up to the advent of the sexual revolution and the privileging of erotic freedom over ethical mating—so many millions of intelligent and even powerful Jewish and Muslim males never spoke up about their alleged victimization?

Let’s set aside the rights-based rhetoric. It's really about sex: Circumcised men have greater pre-orgasmic endurance; non-circumcision permits more frequent ejaculations. What matters most to the anti-circumcision activists is their diminished pleasure with frequently changing sexual partners, as befits an era where the number of conquests is a more common metric of romantic success than long-term relationships. Legislators have better things to worry about than this. I think that those advocation the legislators to look into this issue of genital mutilation are really trying to prevent circumcision in male infants.

I say this because in the United States, there are laws that prohibit female genital mutilation. The current U.S. federal law enacted on September 30, 1996 states in part;

“Whoever knowingly circumcises, excises, or infibulates the whole or any part of the labia majora or labia minora or clitoris of another person who has not attained the age of 18 years shall be fined under this title or imprisoned not more than 5 years, or both.”

The legislators in California should not place this issue on their agenda as the debates would go on and on resulting in more important issues being side-lined.

Canada has no laws restricting male circumcision, despite recommendations from the Canadian Paediatric Society that the procedure not be routinely performed on infants. I suppose there are some people who believe that the Canadian government should pass legislation to prevent parents, religious leaders and health-care professionals from performing and authorizing ritual circumcisions on children. In my opinion, I agree that circumcision shouldn’t be done simply for religious reasons alone.

No doubt the oldest justifications for male circumcision are religious superstitions rooted in the dogmas of Judaism and Islam. While today many religious traditions are not considered threatening to individual freedom, there could not possibly be a grosser violation of a child’s personal liberty than having parts of his genitals cut away in the name of a faith to which he cannot possibly have chosen to follow. I acknowledge this in the case of female genital mutilation, which is universally condemned despite its religious justifications, but some will say that we fail to apply the same logic in the case of male genital mutilation, which continues to enjoy widespread legitimacy.

If it should be done, it should be done for health reasons only. Even the American Federal legislation with respect to FGM states, and I quote;

“A surgical operation is not a violation of this section if the operation is— (1) necessary to the health of the person on whom it is performed, and is performed by a person licensed in the place of its performance as a medical practitioner; or
(2) performed on a person in labor or who has just given birth and is performed for medical purposes connected with that labor or birth by a person licensed in the place it is performed as a medical practitioner, midwife, or person in training to become such a practitioner or midwife.”

There were several other justifications that parents gave for having their sons circumcised. Perhaps the most common ones were appeals to aesthetic preference, derived from the Western tradition of routinely circumcising infant boys, which was standardized even among non-Jews in the 20th century as a means of discouraging masturbation. The prevalence of circumcision in some parts of Canada is also cited, as many parents fear that leaving their sons intact will subject them to teasing from their peers—which has happened in the past.

Some will argue that while parents’ intentions may be honourable, this demonstrates precisely why the practice should be outlawed. As long as the moral question of circumcision is left only in the hands of parents, their decision will be impacted by the choice of other parents to go through with the procedure. The ethics of routine circumcision is an important social question which involves everyone.

As I said earlier in this piece, research has shown that the procedure can reduce a man’s chances of contracting and spreading HIV or STD. This discovery has added a new dimension to this debate, as advocates of circumcision can cite such findings to encourage the practice.

Educating adolescents about sexual health and condom use before they become sexually active is one means of curbing the spread of HIV and STD. Irresponsible sexual behaviour — not foreskin — is at fault for spreading sexually transmitted diseases. That’s true but if young people were responsible in their relations with others, HIV and STD wouldn’t be so prevalent. Because millions of young people are not as careful about their sexual relationships with others (such as using condoms) circumcision at least is another means of preventing these diseases attacking some of those boys and men who are circumcised. Call it Plan B if you wish. It is like having a second wall to protect you when the first wall has been breached.

These are all perfectly legitimate reasons for an adult man to choose to undergo a circumcision. Some people however will argue that the procedure should not be imposed upon an infant before he understands what is being performed on him. They will say that the debate about whether or not circumcision is a worthwhile operation should involve those who can actually make a decision about their own circumcision status, not infants who have no say in the matter. They argue that outlawing routine circumcisions would protect the liberty of children too young to make informed decisions about their own health, children who would otherwise be forced to live with the results of their parent’s choice for the rest of their lives.

I don’t accept that reasoning. I remember as a small child pulling my arm away from the nurse when she was inoculating me. There is no doubt that my rights were to some degree violated but I am also well aware that the inoculations were given to me for my own good. I honestly believe that the circumcision of male infants is for their own good and if it is done for health reasons and not solely for religious reasons, it should be recognized as a proper procedure.

UPDATE:  November 29, 2013

An Israeli rabbinic court fined a mother hundreds of dollars for refusing to permit her baby son to be
circumcised. The court ruled that the circumcision was for the boy's welfare. She was told she will be fined $150 each day the boy isn't circumcised. There is no law in Israel requiring male boys to be circumcised but the vast majority of newborns in Israel are circumcised at least eight days after they are born. The rabbinic court however has overriding authority on matters that effects the welfare of children. The Israelis Justice Ministry is representing the mother and this matter is going to be appealed to the Israelis Supreme Court. I will keep you abreast of what that court's decision will be when I learn of the decision.

UPDATE:  May 25, 2015: Israel’s Supreme Court  overturned the ruling by a court of rabbis, which stipulated that the mother was required to have her son circumcised under the terms of her divorce, and despite the potential ill-effects on the child’s health. A woman in Florida refused to permit her son to be circumcised  against the wishes of her estranged common law husband. She was sentenced to jail  and after nine months in jail, she consented to the circumcision of her son and was released from jail.

1 comment:

Jennifer said...

I appreciate you trying to state all the varying opinions, though you did dismiss some in the name of your opinion. You must be circumcised and trying to justify your loss of manhood.
I am sure you won't approve this comment ;)