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I was recently surprised to learn that many Americans have been circumcised even though their parents had no religious motivation to go through with it. This in strong contrast with my home country where doctors are frequently refuse to perform the procedure even for religious reasons. The number of circumcised men in America is over 50% according a page I found that tracks circumcision rate in the US.

circumcision rate in America

These seem to be primary motivators for circumcision for non-religious reasons:

  • It's cleaner.
  • It's healthier.
  • It leads for increased feeling and better sex for men.
  • Fear of their child being alienated.

How much credibility do these have, are there other non-religious motivators and do the benefits really out weight the downsides and the risk of surgery?

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Related question on Parenting: parenting.stackexchange.com/questions/1443/… –  JYelton May 13 '11 at 15:50
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shouldn't this be tagged [united-states]? –  vartec Mar 5 '13 at 17:04

5 Answers 5

up vote 52 down vote accepted

There is basically no scientific consensus to support "circumcision would lead to a better life quality".

A circumcised penis is not necessarily cleaner nor healthier. That depends mostly on personal hygiene.

Circumcision is a minor surgical procedure and, like all procedures, has potential to cause complications.

There is an ongoing debate about whether circumcision increases or decreases overall likelihood of transmitting disease. For instance, the CDC claims that circumcision reduces the risk that a man will receive HIV from a female partner and this claim is disputed by different organizations. Because of varying concerns about the risk/benefit of the procedure even the CDC has stopped short of recommending circumcision.

There are legitimate concerns that circumcision might reduce sexual enjoyment. The corona below the foreskin is more sensitive than the penile sheath (or foreskin) which is removed during circumcision. Supposedly the corona gradually loses sensitivity due to constant contact with other surfaces. No consensus on this has been reached..

From a social perspective, many US women prefer circumcised men and even demonstrate discomfort around uncircumcised ones. One reason might be the high rate of circumcision. Also, the US could be the only developed country doing the procedure so prominently.

From an ethical perspective, some say it's a human rights issue. Grown men can and should decide for themselves if they'd like to undergo the procedure. Infants have no choice but they are still a big target audience in the US.

Lastly, for the TL;DR; folks, there are at least two celebrity skeptics who spoke out against circumcision: Joshie Berger, in an interview for the SGU; and Penn Jillette on his show Bullshit!. Here's his quote:

"... Suddenly circumcision prevented diseases. Now we find that's bullshit too so the only excuse we have now is conformity."

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That article on "worse sex" provides only anecdotal evidence and the science doesn't back this claim up at all. It also indicates that circumcised males show less sexual dysfunction. :P –  jennyfofenny Mar 28 '11 at 18:59
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@jenny hmm... Thinking better, maybe I should change / remove that claim. It's almost like arguing about female's G spot - sexual sensations are way too subjective. –  Cawas Mar 28 '11 at 19:06
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@jenny now that rate is only among proper made surgery. The problem on complications, I left it clear, is only on other cases and reason alone why circumcision shouldn't be made a "popular mean" to prevent HIV. That to me also says we're not, as a global society, ready to have any surgery made popular. –  Cawas Mar 28 '11 at 19:59
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One downside of circumcision of newborns that you did not mention is that it is a permanent decision made without any input from the person it is performed on. To me, it seems more humane to forgo circumcision and to let the child make his own decision once he becomes an adult. –  Scott Mitchell Mar 28 '11 at 21:49
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I'm impressed how you've turned a rather poor answer that was being down voted by several people (you still have 5 down votes) and instead responded constructively to peoples criticism, provided sources for the claims you could support, went back on the ones you couldn't source and kept engaging in the conversation. Well done. –  Kit Sunde Apr 25 '11 at 4:19

There is certainly not a clear advantage.

Such widespread circumcision of babies can only be found in the United States and Canada1, out of the G8 countries. All other G8 countries - which have good, equal or better, health care systems with respect to the United States and Canada, do not practice it as a norm, or actively discourage it. They do practice circumcision for more serious (real?) health concerns, obviously.

In Christian Orthodox Europe, Africa and Asia, there is a much higher prevalence, but this is due to religious practice and not medical concerns. India and China do not practice it. enter image description here

All this data is made available by the WHO.

Note that if the debate in the US has settled on "there are pros and cons", in Europe the debate goes from "it is acceptable for 'ritual' reasons" to "it should be banned as genital maiming". It is unclear though whether there are any particular side-effects, besides the unavoidable risks of performing a surgical operation on a baby.

So to answer your question more directly:

  • There is no clear-cut balance between circumcision being ultimately positive or negative. Different health organizations have very different opinions on this, even comparing only similar countries in terms of GDP and health standards.

  • As such, it cannot be said with any confidence that there is a net increase in quality of life.

  • If there were such an obvious objective assessment (think for example of antibiotics), the use would be generally recommended by all health systems.


1: Only the English speaking provinces of Canada.

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@Sklivvz I downvoted your answer because it is just plain wrong -- especially the first, intriguingly bolded sentence. Circumcision has a large and positive effect on the health of sub-Saharan Africans exposed to HIV and other sexually transmitted diseases, both as a prophylactic measure and a treatment measure. A study in the Journal of Infectious Diseases found that circumcision reduced comorbidity of HPV in HIV-positive men, –  Uticensis Mar 26 '11 at 20:42
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@Billare: I didn't say that there are no positive effects - and all you cited are correct. However there are also problems: risks with the surgical procedure, and psychological risks for the baby. Those are also documented by studies (of European origin). The balance of pros and cons, according to 2/3rds of the world population (and corresponding health systems) is "it's not worth it". As a side note, you should have posted those comments as an answer and not as comments - they are well researched and they should be voted upon!? –  Sklivvz Mar 26 '11 at 21:18
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@Billare: If you disagree, write a better answer. –  Borror0 Mar 26 '11 at 22:06
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@Billare In general, the 'big three' studies performed in Africa regarding HIV and circumcision were flawed. futuremedicine.com/doi/full/10.2217/17469600.2.3.193 –  Darwy Mar 27 '11 at 19:21
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I think the statement "India and China" do not practice it (as well as saying similar things about other countries) is an overgeneralization and soemwhat misleading. The main reason for circumcision remains religion. You cannot simply chart it by country. For example, if you count the muslims in India, you will find near 100% of the population practice circumcision. The notion that being in a certain country means that custom is not practised is not really correct. –  MAK Mar 28 '11 at 5:04

The CDC concludes that circumcision does reduce risk of disease based on multiple lab studies and controlled intervention trials, in addition to the statistical research that opponents focus on for "refuting" the evidence.

Without addressing any spurious claims about countries' "superior" health care systems, and avoiding the broadband use of wikipedia and pictures to draw emotic correlative arguments on a topic where real research has been done, it boils down to this:

Research indicates reduced disease risk for circumcised men. The question to be answered then is, do you feel that less risk of disease is synonymous with higher quality of life? Assuming that the "better sex" one can experience with a foreskin is true, then it becomes an individual question of -- Does better sexual enjoyment provide enough quality of life to counter balance the increased risk?

There are some myths about the difficulty or need cleaning, which Medline seems to clear up by saying to wash it like you do everything else. Personally I do not see the difference of three minutes of cleaning either way to be a quality of life concern.

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The study you cite deals with HIV only. This might be interesting in countries with a high incidence rate of HIV, but how does this apparent advantage balance with the possible complications in countries where HIV is rare? Is there any advantage if you're able to maintain a reasonable level of personal hygiene? –  Sjoerd C. de Vries Mar 28 '11 at 22:07
    
@Sjoerd -- Do you know of any countries where HIV is rare? Note that I do not consider 0.5% to be rare for a terminal disease. Most of the countries where complications are more likely from circumcision also have high incidence of STDs. These two factors are correlated strongly with poverty. –  Russell Steen Mar 30 '11 at 16:07
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en.wikipedia.org/wiki/File:HIV_Epidem.png There's a ton of them that go bellow 0.5% even <0.1% have a few countries. It's also not THAT terminal if you get medicated (20-50 years is a long time to live). –  Kit Sunde Mar 31 '11 at 7:03
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@Russell And then, there's another way to look at it. Do you advocate circumcision as a means of STD control? Are you safe if you're circumcised? No, of course not. You still need condoms for HIV protection. The protection factor of condoms is multiples higher than circumcision (even if the studies are right). And if you use condoms, is there any advantage of circumcision? Probably not. –  Sjoerd C. de Vries Mar 31 '11 at 13:29
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In the case of condoms and circumcision, the risk reduction stacks. So, yes, even if you use a condom, you have advantages with circumcision. If you're interested in the topic, I recommend starting here - cdc.gov/condomeffectiveness/references.html –  Russell Steen Mar 31 '11 at 14:51

I would recommend the book "Circumcision, and American health fallacy" by Edward Wallerstein, published in 1980. It shows clearly that evidence has always been skewed, misused or misinterpreted to promote circumcision even as the rationale changed. It's a book that explores all the medical evidence used from 1870 to 1980. (1)

There is no such thing as unbiased information about routine infant circumcision. People either promote it or are against it. This is different from medically needed surgeries, even medically needed circumcisions (where it was performed to correct a condition or pathology of the penis).

Those who promote infant circumcision are based on interpreting statistics to suggest benefits while dismissing any discussion of the functions and value of the foreskin.

Those who are against it interpret the statistics as well, but are also based on the discussion of the sexual functions of the foreskin, and also on the ethical value of self-determination. These structures have been documented by John Taylor (1996-1999)(2), and the sexual effects of circumcision have been documented by Sorrells (2007)(3), Frisch (2011)(4), and more recently Bronselaer (2013)(5)

An important point is that there are adults today who wish they had not been circumcised in infancy. This has been documented by Tim Hammond since 1999(6). This is important because circumcision is not essential for prevention as vaccines are, but it is an irreversible procedure that removes structures that cannot be re-generated. In absence of absolute medical necessity, the removal of this tissue in infancy constitutes a violation of that right to self-determination, and an injury that cannot be repaired.

This is important because we don't see patients complaining from life-saving surgeries. The fact that some circumcised men resent that they were subjected to this surgery shows that it shouldn't be someone else's right to alter a person's body.

The fact that we look for "medical benefits" to justify perpetrating that injury shows that there is something wrong in the thought process.

Circumcision has serious risks and harms. Some of the harm is not the result of a risk, but a normal result of the procedure, as has been documented by the Global Survey of Circumcision Harm (2012) http://circumcisionharm.org/

(1) Wallerstein, E. Circumcision, an American health fallacy. Springer series. Published 1980. http://www.amazon.com/Circumcision-American-Health-Fallacy-Springer/dp/0826132413/ref=sr_1_1?ie=UTF8&qid=1362500156&sr=8-1&keywords=circumcision+an+american+health+fallacy

(2) Taylor, JR. The prepuce: Specialized mucosa of the penis and its loss to circumcision. BJU, Volume 77, Pages 291-295, February 1996. http://www.cirp.org/library/anatomy/taylor/

(3) Sorrells ML. Fine-touch pressure thresholds in the adult penis. BJU Int. 2007 Apr;99(4):864-9. http://www.ncbi.nlm.nih.gov/pubmed/17378847

(4) Frisch M. Male circumcision and sexual function in men and women: a survey-based, cross-sectional study in Denmark. Int J Epidemiol. 2011 Oct;40(5):1367-81. doi: 10.1093/ije/dyr104. Epub 2011 Jun 14. http://www.ncbi.nlm.nih.gov/pubmed/21672947

(5) Bronselaer GA. Male circumcision decreases penile sensitivity as measured in a large cohort. BJU Int. 2013 Feb 4. doi: 10.1111/j.1464-410X.2012.11761.x. [Epub ahead of print] http://www.ncbi.nlm.nih.gov/pubmed/23374102?dopt=Abstract

(6) Hammond T. A preliminary poll of men circumcised in infancy or childhood. BJU Int. 1999 Jan;83 Suppl 1:85-92. http://www.ncbi.nlm.nih.gov/pubmed/10349419 Full text http://www.noharmm.org/bju.htm

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The CDC's site says circumcision on infants is a cost effective way to prevent disease, mainly it speaks about HIV. It does say that the effects of circumcision in homosexual relations is inconclusive, but it does not say the circumcision increases risk. I think this is very strong evidence that circumcision is beneficial.

http://www.cdc.gov/hiv/prevention/research/malecircumcision/

Summary

  • Male circumcision reduces the risk that a man will acquire HIV from an infected female partner, and also lowers the risk of other STDs , penile cancer, and infant urinary tract infection.
  • For female partners, male circumcision reduces the risk of cervical cancer, genital ulceration, bacterial vaginosis, trichomoniasis, and HPV. Although male circumcision has risks including pain, bleeding, and infection, more serious complications are rare.
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I'm not sure why this is getting voted down. Is the CDC not considered a reliable source? –  Kit Sunde Dec 24 '13 at 6:33
    
Has my post been voted down because it was so short? Is it considered inappropriate to direct users to another site without writing the information out here? I just want to know why this is getting voted down. –  E Tam Apr 8 at 23:03
    
Yes it's appropriate (i.e. normal, expected, and perhaps required) to include a direct quote inline your answer, from the site you reference: to show why the reference is relevant; so that people know which part of the referenced web page or web site you're referring them to; so that people don't have to read the referenced site to understand your answer; in case the hyperlink URL becomes out-of-date (if the structure of the linked web site changes). –  ChrisW Aug 19 at 13:39

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