A Primer on Male Circumcision
I've never really thought much about my own circumcision. I certainly don't remember it, and there is no sense of 'loss' or 'change' over that part of my body which was removed when I was very young. The way my genitals look now is 'normal' to me, and the only way I've ever known them to be. My parents had me circumcised because it was also 'normal' for Christians in the United States to do so, and perhaps, in some small part, because there were claims made about the health benefits of doing so.
We were nominally Christian. Social Christians. We went to church from time to time as a way to get out of the house, but beyond those occasional Sunday outtings, religion was not a part of our lives. Yet, despite that, my parents had decided that chopping off a part of my body was the right thing to do, a religious ritual worth following, and these days, I am concerned that millions of people will so easily accept that cutting off a part of the male anatomy is 'normal.' I decided to learn more about the ritual, its history, and the arguments for and against the procedure. My research changed the way I approach the subject somewhat, and left me with a more nuanced stance on the issue.
History of Circumcision
A good place to start learning about most any subject is Wikipedia. No, it is not a primary source, and yes, it can and does contain inaccuracies. But it is, in my experience, more accurate on most basic subjects than any random non-Wikipedia source you might find, and so I started there. Circumcision, like a lot of rituals reaching back thousands of years, has no clear 'beginning.' Various theories hold that it was a way of increasing fertility, a religious ritual, cleanliness, a way to 'welcome' a boy into manhood (ouch!), a means of telling the 'in group' from the 'out group', and as an anti-masturbation procedure.
This list is not comprehensive, and other theories have been proposed, some more plausible than others. Regardless, the tradition of circumcision likely goes back to sub-equatorial African societies, with surviving evidence for the ritual found in Ancient Egypt. By the time written histories had become common, Semitic populations had adopted it widely. Judaism has a long history of performing the act, and several passages make clear that God demanded it of the chosen people. Genesis 17:10-14 (NIV):
Male circumcision ebbed and flowed over hundreds of years, some cultures gradually adopting the practice, whether as a whole or for special castes or classes, while others, such as the Greeks, frowned upon the act and saw the ritual decline.
Jews, however, continued to hold to the doctrine written in Genesis, and due to perscution from various groups, developed alternative ways of conducting a circumcision so as to still appear uncut. This lead, eventually, to a step in the process known as Metzitzah, which involved a mohel sucking the blood from the cut as part of the ritual. While this practice has been largely eliminated, it nonetheless continues to this day, and every few months, there are news stories of infants contracting Herpes and other conditions as a result.
Christians, on the other hand, went the other way, tending to disfavor circumcision, at least for a while. Paul said that it didn't matter. There was strong pressure to become separated from the Jewish populations, and along with that, circumcision waned amongst Christians. According to the Gospel of Thomas Saying 53, Jesus said:
"His disciples said to him, "is circumcision useful or not?" He said to them, "If it were useful, their father would produce children already circumcised from their mother. Rather, the true circumcision in spirit has become profitable in every respect.""
The Catholic Church condemned it, and as the practice waned, the ritual was largely isolated in Jewish, Muslim, and some tribal societies.
The Revival of Circumcision
It has only been in the last 150 years or so that circumcision has been seen as a positive and desirable practice in English-speaking parts of the world, and specifically in the United States, where adoption of the practice began to grow strongly in the latter decades of the 19th Century. According to Wikipedia:
There were two related concerns that led to the widespread adoption of this surgical procedure at this time. The first, was a growing belief within the medical community regarding the efficacy of circumcision in reducing the risk of contracting sexually transmitted diseases, such as syphilis. The second, was the notion that circumcision would lessen the urge towards masturbation, or "self abuse" as it was often called.
It was the explosion of medical practice and knowledge that helped bring back circumcision. It was also the revival of puritanistic Christianity, which viewed masturbation as undesirable or sinful, that fueled the growth of the ritual. Together, these two forces established the groundwork for the modern, widespread belief in the United States and other English-speaking countries that circumcision is what is 'normal.'
There was contention for decades as to the medical benefits of circumcision. The position of the American Medical Association was changed in the late 1980s, and refined in 2011, altering the stance that there were no medical advantages to circumcision. Addressing attempts to ban the procedure, the organization stated in 2011:
"There is strong evidence documenting the health benefits of male circumcision, and it is a low-risk procedure, said Peter W. Carmel, M.D., AMA president. "Today the AMA again made it clear that it will oppose any attempts to intrude into legitimate medical practice and the informed choices of patients."
In 2012, the American Academy of Pediatrics concurred, stating that "the health benefits of newborn male circumcision outweight the risks."
Among those benefits, according to researchers and top medical organizations, are included:
- reduction in the risk of urinary tract infection
- reduction in the risk of HIV infection, as well as other STIs, especially in heterosexual males
- reduction in risk of penile cancer
- reduced risks to female partners of many conditions, including cervical cancer and HPV infection.
The Adverse Affects
Despite the overall benefits 'outweigh[ing] the risks', as stated by the AAP, the procedure is not without such risks. Among them are:
- Infections at the incision sites.
- buried (concealed) penis
- skin bridges, urethral fistulas, meatal stenosis
- some sexual dysfunction, though a meta-study has shown no statistically significant correlation between circumcision and sexual side-effects.
- Psychological issues and the experience of pain
Before I started researching this subject, I was fully prepared to find evidence of harm outweighing benefits. I'd read stories, such as the ones involving ultra-conservative Jewish rituals that passed herpes on to infants, and the occasional anecdote of a botched procedure. I expected to find no compelling evidence that circumcision had enough significant benefits to encourage its practice.
Now, I'm less certain of that stance. I'm still unconvinced that the overall benefit (the reduced infection risks, the reduced cancer risks) are significant enough to overcome my strongly-held objections to cutting off the foreskin of an infant who cannot consent. That said, the reversal of the medical community, especially the AMA and AAP, on this issue was surprising and one I did not expect. It is clear that there is significant research which shows the benefits and as such, I'm less against this than I was going in.
That said, I fall back on my statement above about consent. Many of the benefits of circumcision are sexual in nature. For the first dozen-plus years of a boy's life, the benefits appear to have no statistical significance. The idea that a part of my body was removed without my consent and for what, in my non-expert opinion, is a marginal reduction in risk, makes me side with being generally opposed to the procedure until a boy is capable of understanding the situation and the risks involved.
Given that, I seriously doubt many would opt in their early-to-late teens to be circumsized. Even with the religious compulsion in Abrahamic cultures, if allowed to choose freely, it is hard to imagine that boys in their teens would opt to be circumsized at the same rate that their parents opted to do so earlier in life.
This is a more complicated situation than I first believed, with a long history and a series of twists that leave us with a majority of the US male population circumsized without first consenting. More research needs to be done, obviously, and more compelling benefits need to be proven before I'm willing to agree that circumcision is medically 'necessary' and not just a marginal benefit. But, clearly, I've become more nuanced in my stance and am more willing to explore the concept as evidence for and against is produced over time.