It is not at all usual that I find myself grinning at the result of medical research; I’ve been rather successful at maintaining equipoise on quite a range of research issues, but not on male circumcision. My first serious non-medical engagement with male circumcision occurred during an argument for the rights of a child. My contention was that piercing the ear of a girl child, indoctrinating children into the religion that their parents practice were instances of child abuse.
The retort was simple, a bit below the belt. Will you circumcise your male child? Growing up in southwestern Nigeria, and spending six years in boarding schools with common bathrooms, I never saw an uncircumcised penis. I had taken it for granted that it was normal to remove the prepuce. I did not even know what the prepuce looked like until I got to medical school!
Thankfully, there was at the time of the argument, very fresh evidence of the protective effect of male circumcision against heterosexual HIV transmission in sub-Saharan Africa. I replied in the affirmative. However, it got me thinking: what if this evidence had not existed? Much of the routine male circumcision I had been part would have been illegal, or would at least lack scientific merit.
In a BMJ feature article, Circumcision: Divided we fall, to be published in next week’s edition, Sophie Arie considers how recent research on the drawbacks of routine circumcision in boys is provoking medical bodies in different countries to review their position. I took some malicious pleasure in reading her report of a finding that may debunk the previous HIV protection claims for male circumcision:
“… the African trials are flawed in several ways and, if anything, they show that circumcision can delay infection for heterosexual men, not prevent it. ”
This was backed by evidence that have been largely ignored in the wake of the media frenzy about the new wonder solution to the HIV problem in sub-Saharan Africa: male circumcision. South Africa’s president, Jacob Zuma, recently made a point of getting circumcised to encourage others.
Here are further excerpts from the article:
“For a medically futile operation, not one complication can be justified. In the US and Israel, rates of complication in neonatal circumcisions have consistently been reported at between 0.2% and 0.4%. …research published in BMC Urology in February [2010]concluded that side effects such as bleeding and swelling occurred in roughly 1.5% of all procedures carried out by a medical professional on infants in 12 countries.
The Netherlands: “The Royal Dutch Medical Association became the first to decide that the procedure is not only medically unnecessary but also an abuse of the rights of the child in a similar way to female genital mutilation. Under the Dutch constitution, altering a child’s body without medical reasons is illegal, and the Dutch medical body therefore argues there are grounds for banning routine circumcision of babies and children. It has not, however, called for a legal ban on the procedure for fear that it would drive circumcision underground.”
The UK: “The British Medical Association’s guidance… states that the evidence on health benefits was “insufficient for this alone to be a justification,” but… “as a general rule, however, the BMA believes that parents should be entitled to make choices about how best to promote their children’s interests.””
Australia and New Zealand: “The Australasian Association of Paediatric Surgeons (AAPS) states that “it is considered to be inappropriate and unnecessary as a routine, “…but allows for elective circumcision in children over 6 months old when parents hold a very strong opinion.”
Sweden: “Sweden attempted to ban circumcision after the death of a child from complications in 2001. The initial ban was watered down, and the operation is illegal in Sweden in the first two months after birth.”
Nigeria: ???
If you were given the task of formulating the policy regarding male circumcision in Nigeria, what would you propose? My take on this is that indeed, divided we fall. There’s no reason why female circumcision should be any more frowned at or campaigned against. I like to think the foreskin may be almost as important as the clitoris.
I have raised a similar argument elsewhere but I guess FGM has the weight of history against it. Also the extreme cases – infibulation will almost be likened to castration. Now no one would support that, will they?
Bravo! Can it be that the tide is turning? The circumcisionists have had the field to themselves for a few years, but it’s time the opposition voice was heard. The WHOLE of the claim that “circumcision reduces HIV by 60%” is based on 73 circumcised men who did not get HIV (while 64 did) after a total of 5,400 had been circumcised (and a comparable number left alone as control groups). We know that is the whole of the claim because a Cochrane Review before the trials found insufficient evidence to claim benefit, while another afterwards said there was. But that review seems to have taken those trials very much at face value, and downplayed such things as “attrition bias” – the effect of men dropping out of the trials, their HIV status unknown, as 327 circumcised men (and a similar number of controls) did. Finding you had HIV after a painful and marking operation to prevent it would sour your mind against the trials. (The control group men would drop out because they had simply changed their minds about getting circumcised, as you do.)
And in at least six African countries, according to the National Health and Demographic Surveys, more of the circumcised men have HIV than the non-circumcised. That certainly needs to be explained.
You are right about the foreskin. It has been described as conferring, not just “more sensitivity” but “a symphony of sensation”. Men should not give it up without a very good reason. And of course they should also take every practical measure to protect themselves against HIV.
@myrne_whitman: genital cutting has a range of severity, and the mildest FGC is milder than the average MGC. Some tribal circumcision is very severe indeed. When you compare tribal with tribal, surgical with surgical, they are not so different. It is as human rights abuses that they are most similar.
The alternative to infant circumcision is that you must teach your children how to clean themselves properly. You’ll have to teach your children that they will get HIV/AIDS if they have unprotected reproductive sex with HIV+ prostitutes, unprotected anal sex, or share used needles when shooting up oppiates to cover the depression of having to become circumcised. FredR
“divided we fall.” Circumcision is a dividing of the prepuce from its owner. It causes divission and dissention between brothers, families, and cultures. All of those studies in Africa were designed to prove that the covenent law is not totally useless by people who practice it. I followed all those studies closely and there was one big gaping hole in accurately assesing the outcome. The HIV+ and – statice of the prostitutes used was unknown, making it impossible to know if it was the intact group or the cut group using the HIV+ prostitutes.
Why can’t people see this is just an attempt to cause people to abandon Christianity?
The NY TIMES who is controled by procircs put out an artical showing that from 2006 to 2009 routine infant circumcision rates in the US dropped from 53% down to about 32% because we are becoming aware of the long term psychological and physical problems being caused by sexually traumatising and dammaging infants in a feeble attempt at Preventing the Possibility that they Might or Might Not get ignorance related disseases. The claimed “benifits” are outweighed by the real harms.
Circumcision was recommended by GOD in the bible .Abraham was asked to circumcise all members of his household and himself.Read Genesis 17;23-27,for an understanding of the whole essues.If one is a christian he/she must obey the commandments GOD as Abrsham did.Besides ,there is nothing wrong in male circumcision.
circumcision should be practised as it is commanded in the scripture,(Gen.27;23-27) GOD