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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 48 down vote accepted

A circumcised penis is not cleaner and is not necessarily healthier. Circumcision is a minor surgical operation and has a good potential to bring complications if not done properly. It is highly disputed whether it can increase likelihood of transmitting diseases. There is a big and widely-spread study that says it reduces risk of HIV and it is disputed in different places, and even the same source of the study doesn't have a position on advocating circumcision.

It can be worse sex for men. It's true the corona below the foreskin is more sensible, but once the foreskin is gone the corona gradually loses its sensibility because it's constantly in contact with everything - from underwear to masturbating or having sex. But, this is all way too subjective to have any conclusive analysis.

Socially speaking, in a few countries (notably the USA) women (mostly young) really do have troubles accepting "uncircumcised" men. One reason might be the high rate (more than 50%) of circumcised men in those countries. They get the notion of sex with uncircumcised as being like "eating a banana without peeling". So many men undergo the procedure for this reason, allied with some religion or not.

In the end circumcision boils down to infants (specially in USA) - if you're a grown man you can decide for yourself in case you haven't gone through the procedure. Summing that line of reasoning to a lack of consolidated scientific evidence to support its benefits it should not be preventively done on anyone without his consent. In other words: let your child have the option later on in life by himself.

If you are a grown man trying to make up your mind, another option is to choose an authority figure and just go with it. Then you don't need to read through every reference in this page (not just this answer) or do your own research. See what Penn Jillette has to say about it. A hint: it starts with B. I'll quote a relevant part, just in case:

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

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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 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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@Sklivvz (cont'd) and a landmark study in the journal PloS One found that it reduced the number of bacterial communities in the microbiome of the penis. These are not trivial reductions in infectivity either; they are on the order of 60-80%. Apparently, viruses and bugs and all sorts of little nasties love to live in the foreskin and multiply copiously in those highly innervated and blood rich environs. –  Uticensis Mar 26 '11 at 20:45
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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

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

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