Slice of life: the circumcision debate

Dear Cecil:

My wife and I are expecting a baby boy. Soon we will face the prickly question: to circumcise or not to circumcise? As far as we can determine, the dispute has not been settled which is healthier. As youngsters we heard that circumcision fosters cleanliness. Then we heard that this argument is feeble in a society familiar with the concept of soap. Then we heard of correlations between uncircumcised penises and cancers of the prostate and vagina. Then we heard that these reports are bunk. If you can resolve these questions, great.

But it's the sexual angle that most intrigues us at the moment. Which choice is the right one in terms of the sex life of the boy and a future partner? Some argue that circumcision is cruel because a circumcised penis is less sensitive, providing the man less sexual stimulation. Others counter that this is a good argument FOR circumcision: a reduction in circumcision delays male climax, providing both partners more satisfaction. What say you, Cecil?

Cecil replies:

I say it doesn’t make much difference, on average. Which is not to say it doesn’t make much difference. It’s just that individual reactions to circumcision run the gamut and there’s no telling how things are going to turn out for your kid.

Cecil knows this because he has been inquiring once again on the Internet — not the most scientific technique in the world, but how else are you going to find out about things like this? I turned up four men who were circumcised as adults and were thus in a position to compare. Two said sex was better before, two said it’s better now. The two who bitched said that over time the foreskinless glans (the tip of the penis) became less sensitive. This may be due to abrasion from clothing. It certainly isn’t because the foreskin contains the greatest concentration of nerve endings, as some circumcision opponents allege; from an anatomical standpoint, God’s little mudguard is basically ordinary skin.

Of the two satisfied customers, one was circumcised because he had a tight foreskin that split and bled copiously during his first attempt at intercourse — admittedly (and mercifully) not a common problem. The other guy just didn’t like the way his stalk looked. Now, he says, not only is he more sensitive, he doesn’t have problems with odors, splash when urinating, or get his foreskin caught in his zipper. Your kid’s prospective partners (in a moment of heterosexism, Cecil assumed they would be women) are also divided in their views; several said an uncircumcised man had more to play with, while others prefer the streamlined look.

This isn’t really helping you, is it? It gets worse. One cost-benefit analysis (Ganiats et al, 1991) found that circumcision had a “net discounted lifetime cost” of $102 and a health cost of 14 hours of healthy life. In other words, you wound up poorer and sicker — but only slightly. “These results suggest that the financial and medical advantages and disadvantages of routine neonatal circumcision cancel each other and that factors other than cost or health outcomes must be used in decision making,” the researchers wrote. But I guess you knew that.

In English-speaking countries routine circumcision of newborns began in the latter 19th century as a quack medical technique intended to curb masturbation and other ills. Circumcision opponents, a passionate lot, decry the practice as “ritual genital mutilation.” Those unhappy with their circumcised members (a common complaint is that the skin is too tight, making intercourse and, yes, masturbation painful without lubrication) sometimes resort to “foreskin restoration,” in which the skin is stretched with clamping devices. Sounds awful, but they say it works.

The medical establishment first began questioning the wisdom of routine circumcision in 1949; since 1971 the American Academy of Pediatrics has opposed it. Apart from cultures where it is done for ritual purposes, it remains common only in the U.S. but is dropping in popularity there — from 86 percent in 1975 to 71 percent in 1984, according to one study.

So chuck it, eh? Not so fast. In 1989 the AAP withdrew its opposition to circumcision because accumulating evidence suggests it does have health benefits, preventing penile cancer and reducing urinary tract infections in infants. And circumcisees do wind up with a basically maintenance free tool. Bottom line? Your kid will survive either way. Flip a coin.

Follow-up: Circumcision sucks

Dear Cecil:

Your column about infant circumcision contained erroneous information. The enclosed remarks by Dr. John Taylor should clarify that “God’s little mudguard” is not basically ordinary skin. It is a high specialized organ that serves several distinct and important purposes.

Arguments about penile cancer and urinary tract infections may be enough to scare American physicians into perpetuating this dubious practice, but the fact is that 85 percent of the world’s males are uncircumcised. Enclosed are two articles from just 35 years ago which seriously promoted female circumcision. It will not be long before we look back with equal horror on male circumcision. Violating the genital integrity of an innocent child of either sex by submitting him or her to unnecessary surgery when s/he cannot consent is genital mutilation and a violation of human rights.

Dear Cecil:

Circumcision reduces sexual sensitivity 50 to 75 percent. No one has the right to do this.

Dear Cecil:

There was talk at my old job that circumcised men had something like one eighth the chance an uncircumcised man has of catching AIDS through unprotected intercourse with an infected woman. My recollection is that catching any venereal disease is less for circumcised than uncircumcised men. My own father was circumcised at eight (very painful) because of smegma, inflammation, etc. — and his was a household that was quite familiar with soap and water; this was not a hygiene problem. Suggested advice: don’t be a dunce, uncover that schwuntz.

We do have a diversity of opinions here, don’t we? To address the points raised in these and similar letters:

– The foreskin is not ordinary skin, but rather is “replete with nerve endings of sexual pleasure.”

The chief evidence for this seems to be research by John Taylor. Dr. Taylor opposes circumcision, has not formally published his research, and is not a specialist in neurology. His remarks on the structure and purpose of the foreskin are highly conjectural and include such statements as, “We haven’t done a strict quantitative study [but] to my mind [certain nerve endings] are rather more commonly found here in the prepuce than they are in the glans of the penis.” It would be foolish on the basis of such work to make any definite statements about the foreskin’s contribution to sexual sensitivity or anything else.

– The medical arguments in favor of circumcision are specious; circumcision causes more medical problems than it prevents.

Not true. Complications from circumcision are low, approximately 0.2 to 0.6 percent. A total of three deaths have been ascribed to circumcision since 1954. In contrast, more than 1,000 U.S. men develop penile cancer each year, 225-317 of whom die. Circumcision effectively prevents penile cancer. Of 60,000 cases since 1930, fewer than 10 have involved circumcised men. Circumcision also eliminates foreskin problems such as inflammation, failure to retract, etc. These persist in non-circumcising nations such as the UK despite presumed familiarity with proper foreskin hygiene.

– Circumcision is performed without anesthesia and is painful.

Anesthesia presents a greater danger to infants. Circumcised infants remember nothing of the operation later in life. There is no evidence for the claim that this early trauma conditions the infant to a life of sexual violence.

– Male circumcision is a violation of human rights comparable to female circumcision. Infants cannot give informed consent; the operation should be delayed until they can.

Female circumcision often destroys the woman’s capacity for sexual pleasure; male circumcision does not. Parents routinely consent to operations on behalf of their minor children. Post-infancy circumcision is far more traumatic and expensive.

– Circumcision reduces the chances of getting AIDS and other venereal diseases.

According to the American Academy of Pediatrics, the evidence for this is conflicting.

The gist of my original column was that no compelling argument could be made either way regarding circumcision. Having read the above, does anybody still have doubts?

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