Routine Circumcision - a Needless Harm

Wright 1 Leland Wright Instructor M. Leggs ENGL 1711, Section 5 13 December 2012 Routine Circumcision – A Needless Harm In traditional Judaism, it is a religious commandment – in the Islamic world, it is a nearuniversal custom. In the United States, it is seen as both a medical practice and a cultural one, often no longer specific to religion. Whatever its perception, male infant circumcision is one of the world's oldest medical practices still in existence. But is this time-honored tradition as innocuous an operation as we're led to think? Male infant circumcision raises a host of concerns that should make any new parents think twice before giving this doubtful gift to their son. Infant circumcision denies the right of a boy to have a say in a permanent and controversial decision about his natural biological identity. It is an extremely painful operation which no newborn baby should be forced to undergo, and it can have negative consequences for a man's sexual life. Those are just three reasons that we should abandon infant circumcision as the harmful and unnecessary custom that it is. Everyone understands the basic idea of circumcision – it surgically removes the foreskin from the male penis. Yet many people in the United States do not actually understand what the foreskin is, so it's important to begin with some background knowledge. The foreskin is a double-sided tube or “sheath” of skin which, in its normal position, is pulled over the head of the penis (the glans) so that the glans is not directly visible. An article on Psychology Today's website describes how in the newborn, and throughout childhood, the foreskin is fused to the glans with connective tissue as part of its natural development, and thus has to be forcibly retracted for circumcision to take place (Narvaez). Wright 2 In an intact (uncircumcised) man, the foreskin pulls back to reveal the head of the penis and provide a large amount of skin to cover the shaft of the penis – an intact man's foreskin constitutes approximately 15 square inches of skin, according to the same Psychology Today article (Narvaez). And although in the United States we are accustomed to the circumcised penis, a survey by the World Health Organization found that 70% of the male world population is intact (World Health Organization 6). Infant circumcision is the permanent and painful removal of the foreskin, at a time when the child can have no possible say in this decision. It's important to remember that every male child is born with a foreskin, and that it is a natural piece of evolved, human anatomy. Do we have any reason to think it is ethical to permanently remove part of a baby's natural anatomy at birth? A man was born with a foreskin just like he was born with eyelids, fingernails, and toenails. They are all parts of his body. It's no stretch of reasoning to say that a child has a right to keep any part of his body until he is mature enough to make his own decision regarding it, especially since, as we'll see, routine infant circumcision is NOT indicated by medical necessity. Baby boys across the United States are being subjected to an irreversible operation that will change their natural biological identities forever, but their inability to speak for themselves has resulted in a negligence of their future ability to make their own decision. And it doesn't matter if, for the boy's parents, circumcision is a religious or cultural decision. Today, we recognize that it's the right of every person to choose their religion or culture themselves. Take circumcision in Judaism as an example: in the past, there would be no question that a boy born to Jewish parents would be Jewish when he grew up, and thus it made sense to decide for him that he would be circumcised as part of Jewish law. But today, there isn't a guarantee that a man born to Jewish parents will want to have been circumcised – even if he chooses to keep his religion. The right to decide on one's body should be available to everybody in the case of circumcision, Wright 3 not just starting at the moment when one is legally adult, because the circumcision of an infant cannot be changed later – a man circumcised as a baby is stuck that way for his whole life. Though medical decisions are often made for young children without their express consent, those decisions are typically made because they cannot be decided at a later time, or in response to an already existing problem. But circumcision can be performed at any time in a man's life - and infant circumcision is not a treatment for a pre-existing medical condition. The problems which circumcision has the potential to reduce – urinary tract infections, HIV/AIDS, penile cancer, and sexually transmitted infections – are either years ahead of the newborn, or are quite uncommon (more about this later on). As Hutson says, “routine circumcision in babies defies standard principles of surgery, as there is no absolute medical indication.” An unnecessary procedure is a procedure that should not be performed, particularly a surgical one. With all this discussion on the ethicalness of infant circumcision, let's not forget that it is extremely painful to a newborn baby. Proponents of infant circumcision sometimes say that newborns feel little pain, and that that is a reason to circumcise during infancy. But, according to Romberg, “absolutely no studies have been conducted that support the belief that infants feel little or no pain” (279). Remember that the foreskin, at birth and during childhood, is fused to the glans with connective tissue (Narvaez). It seems simple, common sense that the procedure of having the foreskin both ripped from the surface of the glans and then amputated would be very, very painful, especially in the newborn. General anaesthesia is considered unsafe for infants, rendering complete pain alleviation impossible – and it's uncertain whether other, partial anaesthetic solutions are adequate to numb the pain of the operation (Romberg 388-9). Moreover, anaesthetic is certainly not employed during the baby's recovery period, and the baby must still endure the trauma of being strapped immobile to an operating board for the surgery. Anaesthesia is always used for circumcision in children and adults – why do we think Wright 4 circumcision wouldn't be painful for a baby? What must it mean for a newborn, upon entering the world, to have one of their first experiences be such a shocking and painful ordeal? They may not remember it consciously later in life – but they will feel the pain as infants. Moreover, though the field of research into infants' long-term physiological response to circumcision is rather sparse, at least one study has indicated that circumcision's impact lasts much longer than the amount of time it takes for the wound to heal – babies in the study who underwent circumcision showed a stronger pain response to routine vaccination months after the procedure, suggesting “an infant analogue of a post-traumatic stress disorder” (Taddio, Katz). Indeed, it's counterintuitive to think that such a traumatic experience would not have lasting negative repercussions in the newborn baby. It's also important to remember that the foreskin, like almost every other part of the human body, is not just there for kicks. It's a valuable organ which contributes to the health of the penis and to the sexual pleasure of its owner. Fleiss describes several important purposes of the foreskin, which are paraphrased throughout the rest of this paragraph: the foreskin serves to cover the glans of the penis, protecting it from dirt, scratches, and abrasions, and keeps the surface of the glans healthy through gland secretions. It rolls back during sex to accommodate the full length of the erection and cover the shaft with skin that is rich in nerve endings, providing a great range of sexual feeling. The rolling sheath of skin acts as a natural lubricant during sexual intercourse, stimulating the female partner without the rougher friction that is inevitable with a circumcised penis. Furthermore, Fleiss writes, “the foreskin fosters intimacy between the two partners by enveloping the glans and maintaining it as an internal organ. The sexual experience is enhanced when the foreskin slips back to allow the male's internal organ, the glans, to meet the female's internal organ, the cervix - a moment of supreme intimacy and beauty” (Fleiss). Wright 5 Evidence of the detrimental effect that circumcision can have on both male and female sexual partners was found in a rigorous study in Denmark by Frisch, Lindholm, and Grønbæk, which found male circumcision to be linked to orgasm difficulty in men and sexual dissatisfaction in women. The negative effect of circumcision is especially dramatic with regards to masturbation; in a study of men circumcised as adults, 63% reported more difficulty in masturbating after the operation (DaiSik, Pang 2). It makes sense that masturbation after circumcision would be reported to be more difficult – the foreskin provides an easily obtainable measure of frictionless stimulation (by rolling over the glans) that would be unavailable to a circumcised man. This is not to say that sex for men is not extremely pleasurable, regardless of their circumcision status. The most important factors in any man's sex life are his feelings for his partner and the satisfaction of his entire sexual experience, which is far more than the sum of one sexual organ – and some men who elected to be circumcised as adults have reported that their sexual experience changed for the better (Bazelon). However, the body of research showing that circumcision generally decreases sexual pleasure should make it clear that routine infant circumcision is an extremely unethical decision, having the potential to take away value from one of the most worthwhile experiences in a man's life. A man who wishes to become circumcised can have the procedure done, and should be allowed to do so, but a circumcised man who wishes to get his foreskin back has no such option. It is only ethical that men should be allowed to make this decision for themselves, rather than have that decision made for them as infants without any guess as to their feelings on the matter (though a baby's cry of pain will tell you how the baby feels - an adult, at least, can undergo the procedure with full anesthesia and post-operative pain relief.) So why is circumcision performed at all? By far the most common arguments brought up Wright 6 in favor of routine, male infant circumcision are those that claim circumcision to be an effective way to combat a range of health issues, including HIV/AIDS, urinary tract infections (UTIs), penile cancer, and numerous STIs. Earp takes the UTIs argument to task by pointing out that urinary tract infections in boys are rare, and are easily treated with antibiotics – what is the point of circumcising all of a population in order to pre-emptively treat a problem that will only affect a few, particularly when there is a much more conservative treatment available for those it will affect? And penile cancer in men is extraordinarily rare. Using circumcision to combat these health problems is like hitting in a roofing nail with a sledgehammer – maybe it works, but is the collateral damage worth the solution? On to HIV/AIDS transmission. The argument that male circumcision combats the transmission of HIV/AIDS is almost entirely based upon three randomized control trials (RCTs) conducted in South Africa, which each showed a 60% comparative reduction in the transmission of AIDS following male circumcision. Randomized control trials are typically seen as the height of medical reliability, yet both the findings and the relevance of these studies is questionable. Earp sums up the results of a study that took a hard look at the design of the African RCTs, and the problems with them are many and serious: “Clinically relevant flaws included 'problematic randomization and selection bias ... lack of placebo-control … experimenter bias … not investigating non-sexual HIV transmission … participant expectation bias, and time-out discrepancy (restraint from sexual activity only by circumcised men)' ” He then goes on to describe the statistical misrepresentation where the studies reported a 60% relative reduction in HIV transmission, when the absolute reduction in the study groups of all three trials was only 1.3% (Earp). Putting all these flaws with the trials to the side, another obvious problem can be seen with the application of the results of those RCTs to America – they were conducted in Africa! Wright 7 No such studies have been conducted in the United States, a place with higher medical standards and a different HIV problem. Our best course of action against heterosexually transmitted AIDS, and against STIs in general, is to promote safe sex and condom use – in the event that circumcision does have a mild protective benefit against STIs, it is far less effective than condom use, which offers near-100% protection. How is it a good idea to circumcise America's children when we must still tell them they have to wear condoms? Rates of STI transmission prevention in circumcised adults are low across the board. It makes no sense to circumcise ten children in their infancy, breaching their ethical rights in a rather alarming way, when only one may end up not receiving an STI as a result. The rest will either contract an STI anyway or do a fine job of practicing safe sex. And even putting that aside, HIV and STD transmission is a complete non-issue for at least the first decade of any man's life. It's completely illogical to circumcise the male infant population as a pre-emptive solution to problems that are all years ahead of them. While the statement that circumcision helps reduces the risk of transmission of sexual infections sounds good at first, closer examination of this argument reveals it to be riddled with holes and fundamentally unsound. Another statement often used in favor of circumcision is that it is “more clean” to be circumcised – with a circumcised penis, there is no moist space formed by the foreskin, susceptible to the buildup of bodily fluids and germs. But contrary to the expectations of circumcised men, this is a non-issue with intact men. Typically, intact men are glad that an optional surgery to remove a part of their penis for good was not performed on them without their consent. Moreover, what's been said about the “lack of cleanliness” of the male foreskin is many times more true for the female vagina – and this is not a problem for women. The glans of the penis, like the woman's vagina, is simply not meant to be exposed like the rest of the skin on Wright 8 the human body – evolution did not design them that way. Both women and the majority of the world's men do fine with the sex organs they were born with; and, besides, such an incredibly personal choice should not be taken away from a man without compelling reason: our personal opinion on how clean a man's penis will be is hardly a sufficient reason to circumcise him at birth. Perhaps one of the greatest reasons that children continue to be circumcised in the United States is that, with our high circumcision rate, we are used to the circumcised penis. The idea of moving skin on the penis weirds us out or disgusts us. But it's important to place mainstream American feelings about the penis in their context – circumcision is simply what we've gotten used to. Before the advent of circumcision, our ancestors couldn't have thought the foreskin to be strange in the slightest. And for the majority of the world's population, the intact penis is what's normal. Abandoning the idea of the natural penis as strange or unwanted will require hard work for some, yet the result for coming generations can only be positive – returning the choice over each man's body into his own hands, and re-acquanting ourselves with our natural body. The potential consequences for a child's later sexual life, the extreme pain of the operation that has to be endured by the newborn, and perhaps most importantly, the inability of an infant to have a choice in the permanent removal of a piece of his natural identity, are all compelling reasons to abandon routine infant circumcision. The arguments in favor of such a radical surgery have fallen short. Let's better ourselves and our society by removing it from the routine hospital environment, so that each man may fully enjoy the right to his natural body. Wright 9 Works Cited Bazelon, Emily. “Or Not To Snip?” Slate. The Slate Group, 13 Feb. 2006. Web. 21 Nov. 2012. DaiSik, Kim, and Pang, Myung-Geol. “The effect of male circumcision on sexuality.” BJU International 99.3 (2007): 619-622. Web. 2 Dec. 2012. Earp, Brian. “The AAP report on circumcision: Bad science + bad ethics = bad medicine.” Practical Ethics. University of Oxford, 30 Aug. 2012. Web. 21 Nov. 2012. Fleiss, Paul M. “The Case Against Circumcision.” Peaceful Parenting. n.p., 6 Nov. 2009. Web. 2 Dec. 2012. Frisch, Morten, Lindholm, Morten, and Grønbæk, Morten. “Male circumcision and sexual function in men and women: a survey-based, cross-sectional study in Denmark.” International Journal of Epidemiology 40.5 (2011): 1367-1381. Web. 2 Dec. 2012. “Male circumcision: global trends and determinants of prevalence, safety and acceptability.” World Health Organization. n.p., 2007. Web. 30 Nov. 2012. Narvaez, Darcia. “Myths About Circumcision You Likely Believe.” Psychology Today. Sussex Publishers, LLC, 11 Sep. 2011. Web. 20 Nov. 2012. Romberg, Rosemary. Circumcision, the Painful Dilemma. South Hadley: Bergin & Garvey, 1985. Print. Taddio, Anna, and Katz, Joel. “Effect of neonatal circumcision on pain response during subsequent routine vaccination.” Lancet 349.9052 (1997): 599. Web. 1 Dec. 2012.