Point & Counterpoint: Circumcision — Should You Snip?
Foreskin Should Stay
Dr. Mark D. Reiss, M.D.
Executive VP, Doctors Opposing Circumcision
"Circumcision is unnecessary, traumatic, harmful, and risky, and really shouldn’t be performed at all.”
No Health Benefits
All of the “health” reasons for circumcision have been debunked. As far as urinary tract infection prevention, we live in the age of antibiotics. If there’s an infection, simply take a few antibiotics. There’s just no reason to cut off a normal, healthy piece of tissue that can be treated by more conservative means.
In medical school, all the penis drawings are uncircumcised. Even now, most doctors don’t know how to deal with the foreskin. They tell the parents to pull it back, to clean it, to look at it — and all this is totally untrue. When a baby is born, the foreskin is attached, and this is normal. The penis head is sensitive and was meant to be an internal organ — the foreskin protects it. Over time, the foreskin will retract on its own. It’s a misunderstanding that it’s supposed to retract by age three or four. Research has shown that 10 is the mean age for retraction, and some boys don’t retract fully until adolescence. I spend half of my time dealing with parents whose baby boys had their penises forcefully retracted, causing pain, trauma, and scarring.
There are countless reasons not to circumcise. First, it’s an extraordinarily painful operation. People may say it’s just a cut, but let no doubt creep into your mind — it is surgery. Even with a local anesthetic, there’s still some pain. And once it wears off, you have a real wound and it’s very painful. Studies show newborns feel pain more acutely than adults. Their blood pressure goes off the charts during circumcision, and steroid levels get extremely high. These are definite indicators of trauma.
It used to be thought that babies didn’t feel anything during circumcision because the memory banks didn’t exist yet. Well, there’s a good deal of evidence now showing while they may not remember it in their conscious mind, the emotional trauma is stored somewhere deep in the primitive part of the brain. It’s an extraordinarily painful and traumatic experience, and the memory will linger somatically.
Risk of Complications
There’s no surgical operation that doesn’t carry risks and problems. Severe bleeding can occur, and every year babies actually die due to the procedure. The numbers aren’t clear because circumcision doesn’t appear as the primary cause of death, but it does happen. There are also chronic complications that might appear later. Approximately 50 percent of the newborn penis’ skin is removed during circumcision, and if too much is taken, there can be erectile dysfunction and sex problems. The foreskin is made to accommodate an erect penis, but if there isn’t enough slack tissue left, erections can be very painful. And, if the scar isn’t symmetrical, the penis can bend so acutely when erect — almost at a right angle — that sex isn’t possible.
Decreases Penile Sensitivity
There’s a belief that the foreskin is just a vestigial organ without use, a dead piece of flesh. Well, organs are there for a reason. The foreskin has the most erotigenically sensitive nerve endings of the entire body. In circumcised men, the circumcision scar is almost uniformly the most sensitive part of the penis. The foreskin has an incredible number of very pleasurable sensations that anyone who’s lost it will never get to experience. Men circumcised as adults almost uniformly say that sensation fell dramatically afterward.
Human Rights Violation
Many people also feel circumcision violates human rights when a parent decides to cut off a normal healthy body part of a minor. People argue with that by saying parents have to make healthy decisions like immunizations. Sure. That’s not cutting off a healthy body part. If people started saying that to prevent breast cancer we should cut off newborn girls’ breasts, there’d be an outcry.
Circumcision Doesn’t Prevent HIV
The current disease of the decade is HIV, which is certainly a monumental crisis, but really pertains more to the epidemic in Africa. Unfortunately, circumcision has been touted as a preventative method. The best way to deal with the HIV epidemic is simply by normal hygiene, safe sex, and condoms. And where did the HIV crisis begin? In the San Francisco bay, within the gay male population. Probably 90 percent of them were circumcised, and it didn’t prevent them from getting AIDS.
Leave Penises Intact
I use the term “intact” in place of “uncircumcised.” I don’t like “uncircumcised” because it implies circumcision is the norm. We of the genital integrity movement want people to think of the male penis as whole and normal, a natural and intact organ.
Dr. Mark Reiss, M.D., is Executive Vice President of Doctors Opposing Circumcision
Snip The Skin
Dr. Edgar Schoen, M.D.
Former Chair, AAP Circumcision Task Force
"Circumcision is a very valuable preventative health measure with multiple medical benefits.”
Protects Against UTIs
An uncircumcised male has 10 times the risk of contracting a severe urinary tract infection in the first year of life. UTIs aren’t bladder infections – they’re potentially fatal kidney infections accompanied by high fevers and bloodstream infections. And they’re most dangerous in the first year, because the kidneys aren’t fully developed. And sure, you can give babies an antibiotic, but in half of severe UTI cases, evidence of scarring remains in the kidneys. So, you don’t want to wait until the child is older to circumcise, because a lot of the disorders it protects against occur during infancy and childhood.
Sterile Urine Samples
When you see a young baby that has a very high fever, one thing you immediately think of is a UTI. To rule it out, you need a sterile urine sample. A circumcised penis gives sterile urine naturally, but because of bacteria under the foreskin, an uncircumcised penis does not. So, for a proper workup, you need to tranquilize the baby and pass a tube in, and it becomes an invasive procedure just to get a sample.
Improved Hygiene & Skin
Local problems are also a concern for uncircumcised boys. Two to three percent will have an infection of the foreskin in the first three or four years. There’s also risk of phimosis, which is the permanent inability to retract the foreskin and occurs in about 1/2 to 1 percent of uncircumcised boys. Local infections and skin disorders like eczema are twice as likely when boys aren’t circumcised. And there’s genital hygiene, of course. People say just a little soap and water will keep an uncircumcised penis clean, but studies show that uncircumcised boys and men generally have poorer genital hygiene.
There are also sexual advantages. Those opposed to circumcision say you need to foreskin for sex, but this doesn’t make sense. Sex is very complex — it starts with hormones in the brain, and it just wouldn’t make sense if the foreskin had anything to do with it. In studies that compare sexual satisfaction before and after adult circumcision, there’s no difference in pleasure. In fact, the opposite appears true. A study found that due to the hygiene factor, circumcised men had more varied sexual activities and were more likely to receive oral sex. Women prefer sex with circumcised men because of the better cleanliness and smell.
Prevention, Not Abuse
There’s the argument that circumcision violates newborn rights. But does that really make sense? We’re talking about something that has significant benefits, just like immunizations. You can’t ask a baby if he wants it, and if you ask when he’s a toddler, he’d say no. The parents make the decisions. We’re talking about a preventative health measure here, not abuse.
Right now, what’s getting the most attention is HIV prevention. At 60 to 70 percent effectiveness in prevention, it’s like some vaccines. Uncircumcised men are also about three times as likely to harbor HPV, which causes both penile and cervical cancer. Almost 100 percent of penile cancer cases are in uncircumcised men. And the risk of cervical cancer doubles in female partners of uncircumcised men. Circumcision also protects against other STDs, particularly Chlamydia (one of the most common STDs in American teens and a cause of infertility). It’s twice as common in women who have sex with uncircumcised men.
Benefits Outweigh Risks
Circumcision is an operation, so there’s always risk of surgical complications. But if it’s performed by an experienced operator, the risk of complication is about one in three hundred. And even if there is bad work performed, these complications are usually minor. In terms of benefits versus risks, there’s just no contest.
Dr. Edgar Schoen, M.D., author of Ed Schoen on Circumcision, is a Clinical Professor of Pediatrics Emeritus at UC-San Francisco, spent 24 years as Chief of Pediatrics at Kaiser Permanente in Oakland and was Chairman of the American Academy of Pediatrics’ 1989 Task Force on Circumcision.