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Tradition, whether cultural or religious, is often viewed as exempt from criticism and critical analysis for fear of being offensive to religious beliefs or due to the fallacious assumption that age or popularity lends merit to an idea. Humanism has often been at odds with cultural, religious, and other traditions because Humanism seeks to examine traditional beliefs and practices through a scientific and empathetic lens. Such an examination often brings to light the negative aspects of traditional belief. This is why Humanism is often seen as an enemy to social conservatism, which is by definition tied to old, and often unexamined, traditions. Humanists should subject all traditions, cultural, religious, or otherwise to unbiased examination in order to determine whether they are beneficial, detrimental or innocuous. Traditions which are beneficial or neutral should be accepted or tolerated whereas traditions which cause unnecessary harm or otherwise violate human rights should be actively opposed. One such tradition is the practice of routine neonatal circumcision in America.
Genital mutilation, the alteration or removal of the external genitalia for non-medical reasons, takes a wide variety of forms and is performed for a number of different reasons. For example, some persons choose to alter their genitals as a form of expression; this is known as body art or modification. There are also cases of elective procedures performed with patient consent for aesthetic reasons. These forms of genital alteration are not of concern because they are done for personal or medical reasons and are performed with the consent of the individual. Medically indicated procedures used to treat certain rare conditions are not considered mutilations for they have a solid medical purpose. However, neonatal circumcision is a form of genital mutilation which is performed without the consent of the patient and without solid medical justifications. Parents who give consent for the procedure by proxy may feel coerced by tradition or tenuous medical claims. Therefore the routine practice of neonatal circumcision should end.
A History of Routine Neonatal Circumcision
Religious ritual circumcision is antecedent to the modern tradition of non-religious (or not specifically religious) neonatal circumcision. The ancient Egyptians practiced circumcision for religious reasons as did various other cultures though out history. According to the book of Exodus God commanded Abraham to circumcise himself and all of his male descendants as part of the covenant between God and Israel. Any man marrying into Judaism and any slave purchased by an Israelite was also to be circumcised. The Abrahamic faiths Judaism and Islam both explicitly call for circumcision based upon this covenant. The penalty for not observing the circumcision covenant was to be cut off from Israel. In Hebrew the word ’arel’ for uncircumcised is also the word used for that which is unclean or forbidden. Non-Israelite peoples are often negatively referred to as uncircumcised in the bible. Male circumcision either in infancy or adolescence is still practiced by most Jewish and Islamic communities. Ritual circumcision very rarely involves the use of anesthetics as these procedures are usually not performed by medical professionals.
Neonatal circumcision of males is the most common surgical procedure performed in U.S. hospitals.[1] Based on the latest statistical data it is estimated that about 1.2 million infant boys are circumcised annually in the U.S. or about 63% of all newborn males. The percentage of newborns circumcised has been steadily decreasing since the mid 1970s, when circumcision reached its peak in the U.S., with about 85% of all newborns being circumcised. 70% (approx. 102 million men) of the current male population in the U.S. has been circumcised.[2] Before the 1900s routine circumcision in the U.S. was uncommon, usually being routinely practiced only by religious minorities.
Circumcision gained popularity in the U.S. mainly due to the belief that it made masturbation less pleasurable, thereby deterring the behavior. Masturbation was once commonly thought to cause myriad health problems and deviant behavior; insanity, blindness, neuroses, epilepsy, impotence, gonorrhea, and criminal acts such as rape or sexual assault were all once thought to be linked to masturbation. The prevailing religious belief in the U.S., Christianity, surely played a role in demonizing masturbation because most Christians view any sexual act without the intent to fertilize, as sin. Masturbation phobia reached its peak in the late 19th and early 20th centuries, producing a number of torture-inflicting chastity devices and radical surgical procedures, such as clitoridotomy, clitorectomy, infibulation, and ovariotomy for females and cutting of the penile dorsal nerves, blistering of the glans, castration, full excision of the genitalia, circumcision, and surgical implantation of electrodes for males.[3] Circumcision was viewed as the most humane method of achieving the desired effect of decreasing the urge to masturbate by most physicians.
The Purported Medical Benefits of Male Circumcision
Routine circumcision prescribed as a medical prophylactic procedure is a relatively recent invention, beginning in the late 19th century. During this time when little was known about the etiology of disease, circumcision was justified medically as a preventative measure against insanity, depravity, and a whole slew of medical conditions which today we know share no link to the anatomy of the penis. Today there is a continuing trend to try to justify the procedure in a medical context – it is often touted as a way of decreasing the risk of penile cancer, decreasing the incidence of urinary tract infection in newborns, and a guard against HIV and other sexually transmitted infections (STIs).
The prevention of penile cancer is the most easily discredited claim of a medical justification for routine circumcision. Penile cancer is a rare disease in the United States (0.9 to 1 per 100,000),[4] and the incidence of this disease is similarly low in countries which do not practice routine neonatal circumcison.[5] As Sydney Gellis, M.D. writing for the American Journal of Diseases in Childhood states, "There are more deaths each year from circumcision than from cancer of the penis." [6] The American Medical Association corroborates, "because this disease is rare and occurs later in life, the use of circumcision as a preventive practice is not justified." [7]
Some studies suggest that circumcision may reduce the incidence of urinary tract infection (UTI) in the first year of life. One study (which is now widely discredited) shows a ten-fold decrease in the incidence of UTI in circumcised infants.[8] These studies are often used to cite a solid, medical benefit of neonatal circumcision. But "the reliability of these studies has been questioned due to the lack of controls for potential confounders such as prematurity, extent of breastfeeding, and the method of urine collection used to identify bacteriuria (presence of bacteria in the urine)."[7] Premature babies and babies born ill are usually not circumcised due to their health; in these immunocompromised infants there is a higher risk of UTI. This would account for some of the higher incidences of UTI in the uncircumcised. The method of urine collection used to collect samples from uncircumcised infants, catheterization, may cause false bacteriuria, an error overlooked by the researchers. Also, some of the UTIs in these hospital studies are thought to be iatrogenic (unintentionally caused by hospital staff or parents), due to the ill-advised instruction by doctors and nurses unfamiliar with the hygienic care of an intact penis, to forcibly retract the foreskin (which is naturally adhered throughout infancy and early childhood) and scrub the glans and underside of the foreskin. The reported preventative benefit of circumcision appears to be negligible when considering the overall low incidence of UTI in uncircumcised male infants (0.4%-1%)7 – it appears approximately 100 to 200 circumcisions would need to be performed to prevent 1 UTI.[9,10] After factoring in the rate of circumcision complications and the ease of treating UTIs, routine amputation of normal penile anatomy for a small reduction in UTI risk (if one exists) is not even close to being medically justifiable.
There are similar problems with the findings which show a decreased risk of HIV infection in circumcised men. In these studies there has been shown to be a correlation between areas of sub-Saharan Africa where circumcision is commonly performed and a decrease in the incidence of HIV infection. As the medical historian, David L. Gollaher points out, "Circumcision is not random. It remains an expression of powerful cultural and religious ideas. Knowing this, we are apt to wonder whether the circumcised practice different hygiene, engage in different sexual behaviors, or even eat different foods than the uncircumcised." He also points out "the same mapping technique (which shows a correlation between circumcision and HIV infection in Africa) applied to North America would reveal the opposite correlation. The United States has far higher per-capita rates of both circumcision and HIV infection than Canada, but no one has pointed to circumcision to explain the difference."[11] In fact America leads the industrialized world in STI (including HIV) infections and circumcision. If circumcision provides protection why do we see such a high incidence of HIV infection? One theory proposes that the desensitization caused by circumcision leads men to promiscuity in an attempt to achieve satisfaction.
There are many other questions: Could the desensitization caused by circumcision make men less likely to wear condoms? Will uneducated men view this purported protection circumcision offers as more of a protection than it really is and endanger themselves by foregoing the use of condoms? Does female genital mutilation (FGM) offer any protection against HIV or other STIs - if foreskin tissue creates a greater risk for HIV in men what about the labia or clitoral hood (or prepuce) of females? If FGM offered protection it is unlikely that it would be implemented due to its stigmatization in the west, which shows that there is a cultural bias at work. If we are willing to genitally mutilate infant boys for equivocal (at best) protection from disease why should we not consider similar procedures on women?
Even if circumcision is shown to provide a significant protection against HIV infection, it is surely unethical to amputate body parts from unconsenting patients. Sexual education and distributing and encouraging the use of condoms is a more sensible and ethical way to prevent HIV infection than routine genital mutilation. Would we recommend routine neonatal mastectomy to prevent the risk of breast cancer? In the end, the American Academy of Pediatrics provides a fair summary, "Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision."[12]
Routine Male Neonatal Circumcision; What Is It and What Does It Do?
Routine neonatal circumcision of the male is the partial or complete removal of the foreskin (prepuce), which protects the sensitive glans penis (head of the penis) and urinary meatus (urethral opening) when the penis is not erect. The procedure is performed soon after birth. There are several methods by which circumcision may be performed, most involving the use of a clamp which fits around the foreskin to aid in cutting and hemostasis (the stoppage of bleeding) and a scalpel blade. No matter which method is used, they all accomplish the same end – amputation of the foreskin and occasionally the prepucial frenulum – an erogenous zone that is similar to the anchoring flap of skin on the underside of the tongue. Prior to the procedure the infant is commonly placed on a circumcision restraint board with straps for securing the infants limbs. All neonatal circumcision techniques begin by ripping away the foreskin, which is naturally adhered to the glans in infants and young boys in much the same way a fingernail is adhered to the nail bed. This is done by inserting a probe into the opening of the foreskin, and forcing it in between the glans and the foreskin and then slowly moving all the way around ripping the tissues apart. After the glans is free from the foreskin, the foreskin is excised. The baby usually reacts to the procedure by screaming and crying. Shock may cause the child to run risk of choking or of having breathing difficulties.[13] Occasionally the baby will become withdrawn and quiet entering a state of neurogenic shock which is often mistaken for calmness or sleep.[14] After excision of the foreskin the glans appears reddened and is extremely sore. Urine (which is naturally acidic), feces and the abrasive diaper surface cause horrible pain when they come in contact with the inflamed glans. Up to 96% of neonatal circumcisions are performed without any type of anesthesia.[13,15] A 1997 study on the pain associated with circumcision was stopped early rather than subject any more babies to the pain of circumcision sans anesthesia. During the study the researchers found that babies not only experience severe pain but also have an increased risk of choking and breathing difficulty, due to the pain.[13,15]
The low percentage of anesthetic use in neonatal circumcision is primarily due to the long disproved belief that infants do not feel pain, and the ignorant and insensitive view that it does not matter because they will not remember the procedure. Other factors that contribute to low-usage of anesthetics are the patient’s age, which precludes the option of general anesthesia, and problems associated with local anesthetics such as injection pain and reactions to the anesthetic. Topical anesthetics are frequently used (when anesthetics are used at all), but they are almost completely ineffective at controlling the pain of circumcision.[15] Most people would view performing a surgical procedure on a fully conscious adult as an unconscionable act. For some reason this view does not apply to American babies for they are routinely forced to endure an extremely painful procedure with no anesthesia and no regard for their consent, because ’they will not remember it anyways’ and their inability to voice a worded-protest.
Psychologists now know that the brain is highly formative in the infant stages. Although there is an inability to recall memories of infancy the experiences of infancy will shape how the child develops mentally and psychologically. It has been shown that painful experiences during infancy, such as circumcision, can cause psychological trauma which has a profound and lasting effect on the individual. A May 2002 study published by the Journal of Health Psychology concludes that men who were circumcised as babies can go on to suffer a host of psychological problems including Post-Traumatic Stress Disorder (PTSD). In response to the study the US Attorney warned doctors that, "The foundation is well laid for lawsuits." The study states, "PTSD may result from childhood circumcision, just as it does from childhood sexual abuse and rape," and that "some men circumcised in infancy or childhood without their consent have described their present feelings in the language of violation, torture, mutilation, and sexual assault." The study also found that men who were circumcised as babies reported lower self-esteem, feelings of personal vulnerability and experienced problems with rage, depression, phobias, panic and anxiety disorders more commonly than their genitally intact counterparts.[16] Another study showed that circumcised men more commonly experience "shyness, anger, fear, powerlessness, distrust, low self-esteem, relationship difficulties, and sexual shame."[17]
The foreskin is not just extra tissue as some people believe, nor is it a vestigial part of the human anatomy. If the foreskin served no practical purpose, or was detrimental to health, it would have slowly disappeared (or be in the process of doing so) from the human phenotype as a natural process of evolution – we do not see evidence of this occurring. The foreskin is present in the human phenotype because it is an important and functional part of the genital anatomy. It is the most sensitive area of the penis[18] with unique and specialized functions.
Below is a list of the unique structures, cells and tissues lost to circumcision (from "The Lost List" - http://www.norm-socal.org/lost.html):
* The Taylor "ridged band" [sometimes called the "frenar band"], the primary erogenous zone of the male body. This unique, highly specialized and exquisitely sensitive structure is equipped with soft ridges designed by nature to stimulate the female’s inner labia and G-spot during intercourse.
* The frenulum, the highly erogenous V-shaped tethering structure on the underside of the head of the penis. (The frenulum may be either partially or completely removed during circumcision; in some men, it is left largely intact)
* Between 10,000 and 20,000 specialized erotogenic nerve endings of several types, which can feel slight variations in pressure and stretching, subtle changes in temperature, and fine gradations in texture.
* Thousands of coiled fine-touch receptors called Meissner’s corpuscles, which are also found in the fingertips.
Also lost are:
* The foreskin’s gliding action, the non-abrasive gliding of the shaft of the penis within its own sheath, which facilitates smooth, comfortable and pleasurable intercourse for both partners.
* The "subpreputual wetness" which protects the mucosa of the glans (and inner foreskin), and which contains immunoglobulin antibodies and antibacterial and antiviral proteins such as the pathogen-killing enzyme lysozyme, a potent HIV killer which is also found in tears and mothers’ milk.
* Estrogen receptors, the purpose of which is not fully understood.
* The foreskin’s apocrine glands, which produce pheromones.
* The protection and lubrication of the erogenous surface of the penis, which is designed by nature to be an internal organ like the vagina. Natural sex involves contact between two internal organs.[19]
The glans penis is covered with mucosa, a type of tissue that lines internal organs such as the intestines and the inside of the mouth – mucosa is not meant to be constantly exposed to the outside environment. The glans penis of a circumcised individual is noticeably hardened and is less sensitive than the glans of an intact male. There is therefore a decrease in pleasurable sensation produced by masturbation and sex. This is due to the constant exposure of the glans, which is normally ensheathed in the foreskin that protects it from friction and dryness. In order to protect the sensitive glans the body begins the processes of keratinization (or cornification) – moving the tough fibrous protein, keratin, to the surface (much like a calloused hand or foot). The foreskin also provides a natural lubricant and gliding action which makes sex more pleasurable for both partners and makes penetration much easier. Many men circumcised in adulthood report that sex with their partners now requires lubricants and their female partners reported a loss of pleasurable sensation, an increase in vaginal dryness (during sex) and an inability to achieve orgasm.[20,21] It has been hypothesized that the ridged band, which is lost to circumcision, improves female arousal by stimulating the Gräfenberg spot (G spot). The foreskin also eliminates a significant amount of friction which preserves a woman’s lubrication.[19,20] The common female complaints about not being able to produce enough lubricant, or achieve an orgasm during sex (Female Arousal Disorder or FAD) may be related to male circumcision and not dysfunction in the female.[20,21] A fine touch pressure study performed at Michigan State University has shown that not only does circumcision ablate the most sensitive parts of the penis, it also causes a decrease in the sensitivity of the glans.[18] The peer-reviewed urology journal, Urology Today, states: "This study suggests that the transitional region from the external to the internal prepuce is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis. It appears that circumcision ablates the most sensitive parts of the penis." [22]
There are many complications associated with circumcision. The exact complication rate of the procedure is unknown. Excessive bleeding and infection are the most common complications. Bleeding may be severe if the patient has a clotting disorder – which are not screened for pre-operatively. Infection can lead to sepsis, a serious and potentially fatal infection in the bloodstream.[7] Especially during infancy there is an increased risk of meatitis, meatal stenosis and meatal ulceration.[23] Studies have shown a link to many different types of sexual dysfunction including impotence, desensitization which makes ejaculation difficult or impossible, painful erections, painful intercourse, premature ejaculation, and chordee (curvature of the penis).[24] The use of local anesthetics during circumcision can cause anaphylactic reactions, necrotic reactions, and systemic toxicity.[7] Accidents during surgery can result in lacerations of the glans, and accidental amputation of parts of the penis which may require sexual reassignment of the individual. Death from routine circumcision is rare but has been documented.[25] Other complications include skin bridges – adhesions formed between the circumcision scar and the glans, hypospadias and epispadias (abnormal positionings of the urethral opening), skin tags, cysts, psychological problems, ulceration of the glans, lymphedema, secondary phimosis, urinary fistulas, and more. [25]
Putting an End to Neonatal Circumcision
In the past few decades there has been a large international effort made by organizations and individuals to end the atrocity of FGM while male genital mutilation such as neonatal circumcision has been largely ignored. It is time that organizations and individuals who oppose FGM end this hypocrisy by opposing all genital mutilations regardless of severity of the procedure or gender of the victim.
People may prefer to not hear the truth about genital mutilation. Many men report feeling uncomfortable, angry, or violated after becoming conscious of what has been done to them by circumcision, they may wish to return to their previous state of ignorance about the issue. Some people may dismiss the controversy over circumcision as not a big deal. Others may maintain a pro-mutilation position, in order to avoid feelings of guilt for their complicity in the genital mutilations of their children. It is important to face these feelings, become aware of what has been done, and come to terms with the pain or the guilt so we may use these feelings constructively. We cannot change what has been done but we can fight to ensure that a future generation does not have to go through this traumatic and unnecessary procedure.
Addendum: Female Genital Mutilation
Female genital mutilation, female genital cutting, and female circumcision are all terms that refer to any procedure "involving partial or total removal of the female external genitalia or other injury to the female genital organs for non-medical reasons."
"Between 100 and 140 million girls and women in the world are estimated to have undergone such procedures, and 3 million girls are estimated to be at risk of undergoing female genital mutilation every year. Female genital mutilation has been documented in 28 countries in Africa and in several countries in Asia and the Middle East. Some forms of the practice have also been reported from other countries, including among certain ethnic groups in Central and South America. There is also evidence of increasing numbers of girls and women living outside their place of origin, including in North America and western Europe, who have undergone or may be at risk of undergoing female genital mutilation." – The World Health Organization
The World Health Organization (WHO) puts FGM into four different classifications: Type I, II, III, and IV.
Type I: This form involves removal of the clitoral hood – "hoo..omy" (or "clitoridotomy") with or without excision of the clitoris.
Type II: This type involves excision of the clitoris and the labia minora. It is called khafd (reduction) in Arabic speaking countries.
Type III: Is known as infibulation or Pharaonic circumcision. It involves removal of all external female genitalia and the suturing of the vaginal opening. Only a small hole is left open for the draining of urine and menstrual flow. This opening is sometimes re-opened by the woman’s husband for intercourse or by midwives during childbirth, it is subsequently re-sutured.
Type IV: Is the miscellaneous category for mutilations which are non-traditional or obscure.
FGM types II and III are considerably more severe mutilations than male circumcision, Type I (without removal of the clitoris) is analogous to male circumcision.
1. Healthcare Cost and Utilization Project – http://www.ahrq.gov/data/hcup/factbk7/factbk7b.htm.
2. Population .. U.S. Bureau of the Census; Circumcision .. Wallerstein.
3. H. Tristram Engelhardt, "The Disease of Masturbation: Values and the Concept of Disease," Bulletin of the History of Medicine, Vol. 48 (1974), 244-5.
4. Cutler SJ, Young JL Jr (eds): Third National Cancer Survey: Incidence Data. National Cancer Institute Monograph 41. Bethesda, Md, US Dept of Health, Education, and Welfare, Public Health Service, 1975.
5. Wallerstein, Edward. Circumcision: An American Health Fallacy. Springer-Verlag, New York, 1980.
6. Gellis SS. Circumcision. Am J Dis Child 1978; 132: 1168-9.
7. American Medical Association, Report 10 of the Council on Scientific Affairs (I-99), Neonatal circumcision.
8. Wiswell TE, Roscelli JD. Corroborative evidence for the decreased incidence of urinary tract infections in circumcised male infants. Pediatrics 1986; 78: 96-99.
9. Thompson RS. Is routine circumcision indicated in the newborn? An opposing view. J Fam Pract. 1990;31:189-196.
10. To T, Mohammad A, Dick PT, Feldman W. Cohort study of circumcision of newborn boys and subsequent risk of urinary tract infection. Lancet. 1998;352:1813-1816.
11. David L. Gollaher, "Circumcision: A History of the World’s Most Controversial Surgery", pg 103-104.
12. American Academy of Pediatrics, "Circumcision Policy Statement", Pediatrics, 103(3):686-693, March, 1999.
13. Circumcision study halted due to trauma -http://www.cnn.com/HEALTH/9712/23/circumcision.anesthetic.
14. Romberg, R. Circumcision: The Painful Dilemma. South Hadley, MA: Bergin & Garvey, 1985.
15. J. Lander et al, University of Alberta, Edmonton, Canada "Comparison of ring block, dorsal penile nerve block, and topical anesthesia for neonatal circumcision: a randomized controlled trial" http://www.cirp.org/library/pain/lander/
16. Gregory J. Boyle, Phd, Ronald Goldman, Phd, Ephrem Fernandez, J. Steven Svoboda, MA, JD, "Male Circumcision: Pain, Trauma, and Psychosexual Sequelae" Journal of Health Psychology, Volume 07 Issue 03 - Publication Date: 1 May 2002, http://www.cirp.org/library/psych/boyle6/.
17. Rhinehart, J, "Neonatal Circumcision Revistited," Transactional Analysis Journal 29 (1999): 215-221.
18. Sorrells, M, et al., Michigan State University, "Fine-Touch Pressure Thresholds in the Adult Penis," BJU International 99 (2007): 864-869.
19. "The Lost List" - http://www.norm-socal.org/lost.html
20. Bensley GA, and Boyle GJ: Effect of male circumcision on female arousal and orgasm. N Z Med J 116: 595–596, 2003. - http://www.cirp.org/library/sex_function/bensley1/
21. O’Hara K, O’Hara J. The effect of male circumcision on the sexual enjoyment of the female partner. BJU Int 1999;83 Suppl 1:79–84. - http://www.cirp.org/library/anatomy/ohara/
22. Reuters (2007, June 28). Does Circumcision Remove The Most Sensitive Parts Of The Penis? ScienceDaily. Retrieved March 9, 2008, from http://www.sciencedaily.com/releases/2007/06/070627144210.htm
23. Freud, Paul (August 1947). "The ulcerated urethral meatus in male children". The Journal of Pediatrics 31 (2): 131-41. doi:10.1016/S0022-3476(47)80098-8. Retrieved on 2006-07-07.
24. Foreskin Sexual Function/Circumcision Sexual Dysfunction - http://www.cirp.org/library/sex_function/
25. Kaplan, George W., M.D. (August 1983). "Complications of Circumcision" (HTML). UROLOGIC CLINICS OF NORTH AMERICA 10 (3): 543–549. Retrieved on 2006-09-29. - http://www.cirp.org/library/complications/kaplan/
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