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The Scientific Case for Circumcision

Germany, take note!

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Billboard in Swaziland promoting circumcision for AIDS prevention.(International Women's Health Coalition/Flickr)

“Male circumcision is a highly significant, lifetime intervention. It is the gift that keeps on giving. It makes sense to put extraordinary resources into it.”

Who would you guess recently offered this paean to foreskin fleecing? A rabbi? An imam? Nope. Try U.S. AIDS coordinator Eric Goosby at a health convention last month for top officials from 80 countries.

This declaration exposes the shoddy logic of a German regional court that has banned religious circumcision, calling the practice a “serious and irreversible interference in the integrity of the human body.” As the AFP reported at the time, Goosby was reflecting a scientific consensus that has been cemented over the last seven years:

Studies show that circumcision can dramatically reduce HIV infections. One study in South Africa last year found new infections fell by 76 percent after a circumcision programme was launched in a township.

In 2006, trials in Kenya, Uganda and South Africa found foreskin removal more than halved men’s risk of HIV infection. Longer-term analysis has found the benefit to be even greater than thought, with a risk reduction of around 60 percent.

The medical success story here is even more remarkable than the AFP lets on. Those original trials, as the New York Times reported upon their publication, were so effective that they

were stopped early by the National Institutes of Health, which was paying for them, because it was apparent that circumcision reduced a man’s risk of contracting AIDS from heterosexual sex by about half. It would have been unethical to continue without offering circumcision to all 8,000 men in the trials, federal health officials said.

Unethical not to circumcise the men. Since then, study after study has confirmed these initial findings, establishing that while circumcision is far from a silver bullet when it comes to arresting HIV, it is undeniably a potent arrow in the quiver of prevention techniques. In light of this, global health organizations have begun a massive effort to circumcise 20 million African men by 2015. Everyone is getting in on the act: Israeli scientists have started training African physicians to perform the procedure. Supported by non-profits like the Bill and Melinda Gates Foundation, companies are competing to produce more efficient circumcision devices because, as the New York Times notes, “most African countries are desperately short of surgeons, and there is no Mohels Without Borders.” And just yesterday, the Times reported on how “a group of legislators in Zimbabwe had themselves circumcised last week to set a good example for the country, most in an impromptu surgical theater in a tent in Parliament House.”

And the benefits aren’t just for Africans. A peer-reviewed study conducted by Centers for Disease Control researchers found that “circumcision would reduce the lifetime risk of HIV diagnosis for all [American] males by 15.7% in the base case analysis, and the reduction ranged from 7.9% among white males to 20.9% for black males,” resulting in a discounted lifetime HIV health care savings of $427 per male. Other scientists have recently argued in the American Journal of Public Health and Health Affairs that the lack of Medicaid coverage for circumcision in 17 states perpetuates health inequalities among poor and minority populations who make use of the program and are at high risk for HIV. The American Academy of Pediatrics is soon expected to come out with a new policy pushing circumcision, reversing its prior stance.

Given this impressive scientific consensus as to the medical dividends of male circumcision, the German court’s judgment—which permits circumcision for “medical reasons”—is a confused and ignorant muddle. Some have rightly criticized it as an assault on millennia of Jewish tradition and practice (not to mention Islam), something one would have thought a German court would be sensitive enough to avoid. But the ruling itself, as the research above amply demonstrates, is logically incoherent and factually wrong for a simple reason: All circumcisions are medically beneficial. Whether or not the procedure stems from religious motivations, it will have measurable health benefits. So by the court’s own reasoning, all religious circumcisions ought to be permissible as long as the parents also want the medical dividends—which effectively means that circumcision has not been banned at all. Of course, it is very unlikely that this is what the court intended and much more likely that it was entirely unaware of the scientific consensus surrounding circumcision’s advantages.

But that scientific consensus reveals more than just the follies of this German court; it also exposes the deeply problematic aims of American advocacy groups which seek to outlaw circumcision for the entire United States. If, as global health organizations and years of research suggest, circumcision can have major positive health benefits—particularly for poor minorities who often don’t have access to safe sex instruction and are most at-risk for HIV infection—it is absurd to ban the practice. It’s one thing to abstain from a potentially medically beneficial procedure due to personal convictions; it’s quite another to enforce those convictions coercively on others.

Of course, none of the above research means we should start mandating circumcision. There are many reasons a person might legitimately choose to forgo circumcising their child, from wishing to wait for the child to be fully grown and make the decision for themselves, to being swayed by the (quite inconclusive) research on whether the procedure decreases sexual pleasure. Nor do such scientific findings mean we should avoid criticizing and attempting to reform unnecessary and potentially dangerous elements of religious circumcision rites. But they do tell us that safely administered circumcision can be a public good and is an important option that should be open to all parents who wish to grant their child its benefits.

Ultimately, those who seek to ban circumcision as the essential equivalent of child abuse—from this German court to activists who recently attempted to bar the practice in San Francisco—are doing so in the face of tremendous scientific evidence to the contrary. Their claims are at odds with countless studies, not to mention global health policy. The burden of proof, then, is upon these activists to defend their disregard for this science, not on the majority of Americans who choose to circumcise their children and take advantage of its documented benefits.

After all, individuals are free to discount scientific evidence on the basis of value considerations, even dubious ones, and base their life decisions upon that calculus. But such subjective notions should never form the basis for coercive state policy any more than, well, religion.

Your move, Foreskin Man.

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windigo77 says:

wow. what a pathetically misinformed article.

Ben J says:

It is one thing if consenting adults agree to be circumcised. It is a different thing entirely to circumcise a baby, a child. The operative sentence here is:”After all, individuals are free to discount scientific evidence on the basis of value considerations, even dubious ones, and base their life decisions upon that calculus.” A baby, a child, is an individual. Parents “might wish to grant a child the benefits” of a circumcision? I am grateful my parents granted me the benefit of growing up to make decisions regarding my corporal integrity and practicing safe sex.

fieldinski says:

my jewish dick doesn’t like the idea of surgery and, sorry rabbis, nothing will convince it.

This never had a health component. This is a statist assault on religous practice.

Jacob Arnon says:

Germany by banning circumcision is telling Jews to leave, “there is no place for you in Germany.”

They want, again, a Judenrein Germany.

Jacob Arnon says:

Ban there is no downside to circumcision. Jews prove that every time they win a nobel prize, fight a war or get an olympics medal.

Those opposed to it do it strictly on aesthetic grounds or else on some mythic notion of a “an integral human body.”

Jew hatred drives this movement.

Maybe they’re doing it to get rid of the Turks and they just forgot about the Jews. Remember, Muslims get circumcised too.

Jacob Arnon says:

The law wouldn’t apply to Muslims since they circumcise their children at 13. The Muslims will claim that their children have “given consent.”

It’s a fiction that everyone will be say it’s the truth.

No, it’s all about Jews.

How idiotic.

CountWestwest says:

By your own logic there is no downside to having a natural, uncut male member. Uncircumcised men from every nationality prove that every time they win a Nobel prize, fight a war and win Olympic medals.

BTW. Jews have only won wars fighting against other circumcised men,

Laurel Robertson says:

Jacob… Muslims circumcise at all sorts of ages. And 13 years is still ‘underage’, therefore not applicable. No one is saying don’t circumcise, no one is saying to any group ‘get out of Germany’.

You have invoked Godwin’s Law – you lose (and no, it’s not about Jews, it’s about children who don’t have a voice of their own yet to protect their own rights). To compare this ruling to the Holocaust is to cheapen the memory of your forefathers and relatives who suffered and died under the Nazis.

This law is no more anti-Jewish than the law banning female circumcision is anti Boki tribe. It is not anti-Jewish to protect children from having a functioning sexual organ removed, along with over 20,000 high sensory nerve endings and specialized mucosa and a natural buffer and lubricant. It’s illegal to remove a girl’s clitoral hood, which is the same as removing the male foreskin, despite similar purported (but false) health benefits. Research show much higher associations of sexual problems among men who are circumcised. A study in Korea of men who were cut as adults found half of them said they lost a significant amount of sexual pleasure. The medical associations in Holland, England, South Africa, Finland, Norway, Sweden, Canada, Australia, and others, have all said there is no justifiable basis for infant male circumcision absent a specific medical condition, and some of them frankly called a violation of human rights, which is exactly what it is. Religion and custom do not justify mutilation of body parts of children, just like you can’t tatoo your baby’s face. It’s HIS body, and HIS choice.

Jacob Arnon says:

It’s about Jews, Laurel.

Who cares about “Godwin’s so called law”?

Jews will not tolerate being told that they can’t circumcise their children. If the judges ruling becomes law most Jews will leave Germany.

“Muslims circumcise at all sorts of ages. And 13 years is still ‘underage’,”

Are you German? How do you know what their age of consent is?

Jacob Arnon says:

“This law is no more anti-Jewish than the law banning female circumcision is anti Boki tribe.”

Not a valid comparison. Marc.

Circumcision hasn’t harmed the Jewish people who excel in all fields of human endeavor.

As for your doctors association, it’s non of their business if I decide to circumcise my son.

Jacob Arnon says:

“BTW. Jews have only won wars fighting against other circumcised men,”
Really, why don’t you fight some circumcised Jew or Arab and see who comes out on top.

You sound like a member of stormfront.

Jacob Arnon says:

That’s because your dick isn’t Jewish.

CountWestwest says:

LOL. You must be 12 years old and very insecure about your mutilated manly parts.

Here is a sobering fact: Every year, about 120 children in The US die as a result of their circumcisions. Every year, about 240 children in Africa die as a result of their circumcisions. It is not known how many Islamic children die or how many Jewish children die outside the two above countries. It can be reasonably estimated there are more than 500 deaths every year world wide.
That knocks down any argument in favor of the practice. Any argument falls flat on it’s face.
Now, if you circumcise your child and he dies, you are guilty of murder. You chose to ignore the facts and killed your child. You deserve to serve the time for murder.

Jack Perry says:

How does any one disagree with the point that amputating nerves, blood vessels, protective covering and pleasure zones is bodily HARM?

Finally a country is standing up for the basic human right of a human to keep all of his sensory system, all of his nerves, all of his blood vessels, protective covering and pleasure zones.

Other countries should follow this lead. Baby boy penis parts removal should be considered illegal NOW in the United States under the 1996 federal law banning genital cutting — 14th Amendment equal protection clause.

Those saying that preventing the cutting off of penis parts of a baby boy violates the cutter’s freedom of religion, are way out there in irrational land. One’s religion ends where their knife touches another human’s body. The idea that another human’s ritual (rite) trumps ones right to body parts is insane and creepy. Baby boy penis parts removal cuts off thousands of fine touch and stretch nerves. This is like disconnecting the fingertips, nipples or lips from the brain. No human should be subjected to sensory system harm as well as a forced decrease of sexual function and PLEASURE for life!

Africa isn’t a country and there is not a uniform reporting on the continent. Don’t believe your statistics.

Well, the irony is that African circumcision probably has more health benefits than Jewish circumcision. Let’s face it, there isn’t exactly a huge AIDS epidemic in the Jewish community.

Now is this some sneaky German plot to kick out Jews? I’m inclined to wonder, but I suspect they’re more worried about the Turks right now.

Jacob Arnon says:

I also don’t believe your statistics,
Frank O’Hara.

IN any case, how many people in Africa dies not AIDS because they were not circumcised?

Jacob Arnon says:

I am more secure about my circumcised penis than you are about your “intact” member, CountWW.

I know for a fact that one can have a normal sex life while circumcised while you are still under the childish illusion that circumcision is castration.

You must really fear and hate Jews (Muslims too).

Jacob Arnon says:

“BTW. Jews have only won wars fighting against other circumcised men,”

Jews did very well against superior uncircumcised forces whether in ancient Judea against the Romans or a few circumcised Jewish youngsters with very few arms against the mighty Nazi Wermacht in the Warsaw Ghetto. Of course they lost in the end, but the Imperial Roman armies beat off all the Germanic tribes for five centuries or more that where more numerous and better armed.

OTOH, the mighty uncircumcised ubermentchen proved their “superiority” by murdering babes, women, old men and old women.

Be proud of your mighty uncircumcised aryan member CountWestWest.

Jacob Arnon says:

Count Westwest, stole his name from the circumcised Jew Kafka.

Indeed! It stinks worse than 2 kilos of warm Limburger cheese.
In a strange way, these pathetic attempts at rationalizing or justifying the mutilation of children’s genitals is a good sign. It shows how desperate they’re getting.

CountWestwest says:

It sure took you a long time to Google that, moron.

Les Bergen says:

Please post medical or scientific journal report to support those statistics. Without a source, it smells bogus.

I read the same thing re clitorictomy, not only does it reduce HIV infections, but teenage pregnancy, adultery, and more. In the dark ages and early days of Christianity monks conducted self castration, and were happier men for it. Mahmud Shamsuddin, the Chinese explorer, who led a huge Chinese armada around the Horn of Africa was an empirial eunuch. Why stop at foreskin, I say take it all, be closer to God and live a life of adventure.

Jane S. says:

LOL! There’s always truth in humor, thanks for this post, Theresa, it sure made my day.

Jacob Arnon says:

“Why stop at foreskin, I say take it all, be closer to God and live a life of adventure.”

Theresa, post isn’t funny because she expresses the irrational castration anxieties non circumcised people around the circumcised.

No, Theresa god and Jewish law (I am not a believer) speaks only of the foreskin.

Had we wanted to “take it all” we would have done it 3000 years ago.

Jacob Arnon says:

Windigo

you are mot making an argument but merely ejaculating.

Where was the article “misinformed?”

Jacob Arnon says:

Locuta, it’s the people who want to stop circumcision in the Jewish community that are desperate; not to mention full of castration anxiety.

Marlon Acenas says:

Jake, it’s not too late. No better time than today, buddy.

Jacob Arnon says:

Jane, Theresa, and Marlon seem to be the same bigoted person. or three persons with a single personality.

Careful, Jacob, you might offend Trinitarians!

The ruling arose from the case of a four-year old MUSLIM boy.

You’re right, circumcision has never had a health component. It’s a “cure” looking for a disease, and more generally an intervention looking for an excuse.

Has anybody ever suggested that being circumcised might prevent anyone from fighting a war, winning a Nobel prize or getting an Olympic medal? This defence of circumcision comes up time and time again, and it’s manifestly absurd. The many downsides of circumcision are all – unsurprisingly – in the area where circumcision is performed, though it can have psychological downsides as well – not always, so your shining example is anecdote, not data.

Your comment is so dumba**ed that I feel compelled to butt in to correct a major portion of your ignorant spew.
Jews won many wars against the *uncircumcised* Seleucid Greeks in the 2nd century BCE. Chew on this one.

A logical consequence of the author’s (religiously biased) argument is that, in the absence of the AIDS epidemic (which will eventually be conquered–and certainly not through circumcision), circumcision has no medical justification.
–Greg Pflugfelder (Columbia University)

So are you saying removing a baby’s foreskin turns him into an uebermensch? I really have heard it all!

And the “oy vey”, poor, persecuted Jew shtick is getting wearisome now. One would think you bore the sole brunt of German policies, past and present.

Roger Desmoulins says:

“…those who seek to ban circumcision
as the essential equivalent of child abuse…are doing so in the face of
tremendous scientific evidence to the contrary.”
ME. The African clinical trials are gravely flawed; here’s why:
http://www.salem-news.com/fms/pdf/2011-12_JLM-Boyle-Hill.pdf

As for the other “evidence,” it is generally obtained by comparing data from the USA, mostly circumcised, educated and well off, with data from Third World nations, where health care and hygiene are deficient. These studies overlook that health outcomes are strongly correlated with income and education.

“Their claims are at odds
with countless studies, not to mention global health policy.”
ME. There is no “global health policy” favouring prophylactic circumcision. There is only a WHO opinion, based on the gravely flawed African clinical trials, stating that voluntary adult circumcision could prove useful in the battle against HIV in eastern and southern Africa. Please note that the WHO did NOT speak to the merits of brit milah or of American RIC.

“The burden
of proof, then, is upon these activists to defend their disregard for
this science…”
ME. This “science” consists of badly flawed peer-reviewed articles, that nobody outside of the CDC and WHO has endorsed. The burden of proof rests on those who wish to alter the human body, not on those who defend what Nature Intended.

“…not on the majority of Americans who choose to circumcise
their children…”
ME. Few doctors recommend circumcision nowadays; the procedure is performed only because parents request it. The vast majority of Americans do not have the
urological or sexual knowledge required to make an informed decision
about routine circumcision.

“…and take advantage of its documented benefits.”
ME. The benefits do not exist. Meanwhile, there have yet to be any honest studies of the long term complications of routine infant circumcision, including the occasional adverse effects on adult sexual pleasure and functionality, of both genders. This lacuna alone is ample reason to cease RIC.

concerned cynic says:

The African clinical trials are shoddy science, for reasons that would take us too far afield. The alleged findings of those trial apply to the AIDS belt of eastern and southern Africa, where HIV is suspected of often being transmitted heterosexually. They do not apply to the first world nations around the North Atlantic, where HIV is transmitted by anal intercourse and dirty needles.

Uncircumcised Japan has fewer HIV positive people than circumcised South Korea, despite the fact that the population of Japan is 2.5x that of Korea. Greece and Israel have the same rate of HIV positivity, even though Israel is highly circumcised while Greek men never are. Native born USA adult men are at least 80% circumcised. Nevertheless, the USA has a higher rate of HIV positivity than Canada and Europe. The USA is tied with Portugal, where all drugs have been legalised and hence dirty needles are a major problem. In Europe, only Moslem men are circumcised in significant numbers. There is no evidence that lack of circumcision harms Europe in any way.

http://en.wikipedia.org/?title=List_of_countries_by_HIV/AIDS_adult_prevalence_rate

Routine circumcision suffers from two fundamental problems. One, the rate of short term complications is not well measured. Two, the long term complications for adult sexual pleasure and function have never been studied. Hence when doctors circumcise, they literally do not know what they are doing.

concerned cynic says:

“Male circumcision is a highly significant, lifetime intervention. It is the gift that keeps on giving. It makes sense to put extraordinary resources into it.”
The shoddy logic here is that of the author of the above quote, and the use Rosenberg makes of it. Nowhere is it stated or implied that this justifies the circumcision of minors, or of adults who have not consented thereto. The controversy is not over circumcision per se, but that of minors who, by definition, cannot give informed consent to it.

Because of a phenomenon called risk compensation, a concept that has its own Wikipedia entry, I confidently predict that circumcision campaigns will have no material effect on the extent of HIV positivity in eastern and southern Africa. This will be evident by 2030.

Mohels without Borders, don’t bother forming.

Devin Elgert says:

As a feminist friend of mine who, despite having Jewish relatives refused to have either of her sons circumcised explained – “one very effective means of preventing breast cancer (which would save billions) would be to surgically remove their breast buds when they start going through puberty. So, perhaps the American Pediatric Association will adopt a neutral stance on ‘premature breast-bud removal’ so that parents who are stupid to draw the obvious parallels in terms of violating a child (and his/her right to bodily integrity, sovereignty, and autonomy – the core issues feminists have rallied around for decades) may understand that just because a practice is scientifically sound does not make it ethically sound.

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The Scientific Case for Circumcision

Germany, take note!

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